The efficacy of postoperative incentive spirometry is influenced by the device-specific imposed work of breathing. Incentive spirometry with expiratory positive airway pressure reduces pulmonary complications, improves pulmonary function and 6-minute walk distance in patients undergoing coronary artery bypass graft surgery. Absence of benefit of incentive spirometry in low-risk patients undergoing elective cholecystectomy. A controlled randomized study. Prevention of postoperative pulmonary complications through respiratory rehabilitation: a controlled clinical study. Influence of incentive spirometry on pulmonary volumes after laparotomy. Are maximal inspiratory breathing exercises or incentive spirometry better than early mobilization after cardiopulmonary bypass? Incentive spirometry for tracheostomy and laryngectomy patients. Incentive spirometry does not enhance recovery after thoracic surgery [Impact and Effect of Preoperative Short-term Pulmonary Rehabilitation Training on  Lung Cancer Patients with Mild to Moderate Chronic Obstructive Pulmonary Disease:  A Randomized Trial]. The effectiveness of incentive spirometry with physical therapy for high-risk patients after coronary artery bypass surgery. Incentive spirometry versus routine chest physiotherapy for prevention of pulmonary complications after abdominal surgery A comparative study of IPPB, the incentive spirometer, and blow bottles: the prevention of atelectasis following cardiac surgery. Incentive spirometry to prevent acute pulmonary complications in sickle cell diseases. Risk factors for pulmonary complications after emergency abdominal surgery. [Ineffectiveness of incentive spirometry as coadjuvant of conventional physiotherapy for the prevention of postoperative respiratory complications after thoracic and esophageal surgery]. Systematic short-term pulmonary rehabilitation before lung cancer lobectomy: a randomized trial. The Effect of Abdominal Binders on Postoperative Pulmonary Function Comparison of continuous positive airway pressure, incentive spirometry, and conservative therapy after cardiac operations Sarcopenia: Prevalence, and Impact on Operative and Oncologic Outcomes in the Multimodal Management of Locally Advanced Esophageal Cancer Prevention of respiratory complications after abdominal surgery: a randomised clinical trial Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery: a randomized clinical trial. Postoperative pulmonary complications following thoracic surgery: are there any modifiable risk factors? Postoperative pulmonary complications and lung function in high‐risk patients: a comparison of three physiotherapy regimens after upper abdominal surgery in general anesthesia
STUDY OBJECTIVES The study evaluated the impact of the additional imposed work of breathing ( WBimp ) generated by two different spirometers on postoperative incentive spirometry performance in patients at high risk and moderate risk for postoperative pulmonary complications ( PPCs ) . Additionally , we investigated whether maximal inspiratory pressure ( PImax ) is an easy estimate of the WBimp imposed by incentive spirometers . DESIGN Prospect i ve , r and omized , single-blind clinical trial . SETTING ICU of a university hospital . INTERVENTIONS AND MEASUREMENTS Thirty male patients were assigned to a group at high risk for PPCs ( group A ; inspiratory capacity [ IC ] , < 1.6 L ) or to a group at moderate risk for PPCs ( group B ; IC , 1.6 to 2.5 L ) after upper-abdominal , thoracic , or two-cavity surgery . On the first or second postoperative day WBimp , IC , and PImax were recorded without spirometers ( baseline ) and during incentive spirometry with the Mediflo spirometer ( Medimex ; Hamburg , Germany ) ( high WBimp ) and the Coach spirometer ( Kendall ; Neustadt , Germany ) ( low WBimp ) using a pneumotachograph . In group A , the baseline and the ICs for both spirometers only differed slightly . In group B , the IC was significantly reduced for the Mediflo ( p < 0.05 ) , which imposed a WBimp twice as high as the Coach ( p < 0.01 ) . PImax was significantly increased for both the Mediflo and the Coach ( p < 0.01 ) . PImax was positively correlated with WBimp ( r = 0.8 ) . CONCLUSIONS Incentive spirometers differ considerably in their additional Wbimp with a potential impact on the efficacy of postoperative incentive spirometry performance . PImax might be an easy clinical estimate for the WBimp during incentive spirometry . Incentive spirometers with low WBimp permit increased maximal sustained inspiration and , thus , enhanced incentive spirometry performance , and , therefore , it might be more suitable for use in postoperative respiratory care BACKGROUND The use of the incentive spirometry ( IS ) with expiratory positive airway pressure ( EPAP ) to prevent postoperative pulmonary complications ( PPC ) after coronary artery bypass graft ( CABG ) is not well established . This study sought to determine the effects of IS+EPAP after CABG . METHODS Thirty-four patients undergoing CABG were r and omly assigned to a control group or IS+EPAP group . Maximal respiratory pressures , pulmonary function test , 6-minute walk test and chest x-ray were performed at baseline as well as 1 week and 1 month after CABG . RESULTS Maximal inspiratory pressure was significantly higher in the IS+EPAP group compared to controls at both 1 week and 1 month ( P<.001 ) . Maximal expiratory pressure was significantly higher at 1 month compared to 1 week in IS+EPAP group ( P<.01 ) . At 1 month , forced vital capacity and forced expiratory volume in 1 second was significantly higher in IS+EPAP compared to controls ( P<.05 ) . Inspiratory capacity was higher at 1 month in IS+EPAP group compared to controls ( P<.05 ) . The distance walked in 6-minute walk test was higher at 1 month in IS+EPAP group ( P<.001 ) compared to controls . Lastly , radiological injury score at 1 week was lower in IS+EPAP compared to controls ( P<.004 ) . CONCLUSIONS In patients undergoing CABG , IS+EPAP results in improved pulmonary function and 6-minute walk distance as well as a reduction in PPC To determine the potential benefit of incentive spirometry , which has been advocated to prevent pulmonary complications after upper-abdominal surgery , we compared a group of patients receiving incentive spirometry  to another group receiving no specialized postoperative respiratory care . Forty patients in the American Society of Anesthesiologists ' class 1 and 2 who were undergoing cholecystectomy ( through right subcostal incision ) were included in the study and were r and omly allocated to one of the two groups . Patients receiving incentive spirometry were encouraged by a specialized respiratory physiotherapist to breathe deeply for five minutes hourly , 12 times daily , for three postoperative days . No statistically significant difference between the two groups was found in the radiologic evidence of postoperative pulmonary complications , arterial oxygen pressure , spirometric measurement , and clinical evaluation at the second or fourth postoperative day ( or both ) . In particular , deterioration on the chest x-ray film at the fourth postoperative day was observed in eight of 20 patients in the group receiving incentive spirometry and in six of 20 in the control group . Our study confirms the postoperative deterioration of respiratory function after upper-abdominal surgery and demonstrates the lack of therapeutic values of  incentive spirometry  in these patients at low risk for pulmonary complications OBJECTIVE To investigate the efficacy of respiratory rehabilitation in preventing postoperative pulmonary complications ( PPC )  and to define which patients can benefit . DESIGN A r and omized clinical trial . SETTING A public hospital . PATIENTS Eighty-one patients who had upper abdominal surgery were distributed into two homogeneous groups : control ( n = 41 ) and rehabilitation ( n = 40 ) . INTERVENTION Breathing exercises in the rehabilitation group . MAIN OUTCOME MEASURES Preoperative and postoperative clinical evaluation , spirometry , arterial gasometry , and simple chest X-rays . RESULTS The incidence of PPC was 7.5 % in the rehabilitation group and 19.5 % in the control group ; the control group also had more radiologic alterations ( p = .01 ) . Stratified PPC analysis did not reveal significant differences between groups . However , high- and moderate-risk patients in the rehabilitation group had fewer PPC . Multivariate analysis showed a greater PPC risk associated with pulmonary history ( p = .02 ) and duration of surgery longer than 120 min ( p = .03 ) , while rehabilitation exerted a protective effect ( p = .06 ) . Significant postoperative decreases in pulmonary volumes and arterial gas values were recorded in both groups , without significant differences . CONCLUSIONS Respiratory rehabilitation protects against PPC and is more effective in moderate- and high-risk patients , but does not affect surgery-induced functional alterations Twenty patients undergoing an upper abdominal procedure were r and omly assigned in two groups . One group was treated with both chest physical therapy and incentive spirometry and the other was treated with chest physical therapy alone .  Spirometric values , respiratory rate , tidal volume and vital capacity were determined during the postoperative course . We observed that patients treated with incentive spirometry bad a faster return to preoperative pulmonary volumes . This observation confirms the prophylactic role of incentive spirometry in the prevention of pulmonary complications after laparotomy Forty-nine adults who had undergone cardiopulmonary bypass surgery were r and omly assigned to one of three exercise programs to determine if either maximal inspiratory breathing exercises or incentive spirometry offered a therapeutic advantage over early mobilization alone . After extubation , the patients started their assigned exercise programs . A physical examination and pulmonary function tests were performed preoperatively , at the start of the exercise program , and 24 and 48 hours after the start of the program . The results showed a significant decrease ( approximately 50 % ) in lung volumes but no airflow obstruction in patients who had coronary artery bypass graft . In those patients who had valve replacement , lung volumes fell , and in addition , mild airflow obstruction occurred . A majority of patients had postoperative pulmonary complications . There were no significant differences among the exercise programs in improving lung volumes and airflow or in preventing postoperative complications . We conclude that maximal inspiratory breathing exercises or incentive spirometry , when used in addition to early mobilization , offers no therapeutic advantage over early mobilization alone after cardiopulmonary bypass surgery Sustained maximal inspiration ( incentive spirometry ) is used for the prevention and management of atelectasis in major abdominal and thoracic surgery . Patients with head and neck surgery are predisposed to postoperative disturbances in lung function after extensive surgical resection , immobilization , or significant chest wall deformity from various reconstructive procedures . The patient often requires tracheostomy or permanent laryngeal stoma . A prospect i ve clinical study on patients with major head and neck surgery was conducted to evaluate the use of incentive spirometry to improve postoperative lung function . An adaptor was first design ed to allow patients with tracheostomy tubes to use the spirometers . Parameters studied include vital signs , arterial blood gases ( A-a gradient ) , and pulmonary function test . Significant improvement of lung function and lack of complication warrant the use of incentive spirometry in postoperative head and neck surgery patients Objective : To investigate the additional effect of incentive spirometry to chest physiotherapy to prevent postoperative pulmonary complications after thoracic surgery for lung and esophageal resections . Design : R and omized controlled trial . Setting : University hospital , intensive care unit , and surgical department . Patients : Sixty‐seven patients ( age , 59 ± 13 yrs ; forced expiratory volume in 1 sec , 93 % ± 22 % predicted ) undergoing elective thoracic surgery for lung ( n = 40 ) or esophagus ( n = 27 ) resection . Interventions : Physiotherapy ( breathing exercises , huffing , and coughing ) ( PT ) plus incentive spirometry ( IS ) was compared with PT alone . Measurements and Main Results : Lung function , body temperature , chest radiograph , white blood cell count , and number of hospital and intensive care unit days were all measured . Pulmonary function was significantly reduced after surgery ( 55 % of the initial value ) and improved significantly in the postoperative period in both groups . However , no differences were observed in the recovery of pulmonary function between the groups . The overall score of the chest radiograph , based on the presence of atelectasis , was similar in both treatment groups . Eight patients ( 12 % ) ( three patients with lobectomy and five with esophagus resection ) developed a pulmonary complication ( abnormal chest radiograph , elevated body temperature and white blood cell count ) , four in each treatment group . Adding IS to regular PT did not reduce hospital or intensive care unit stay . Conclusions : Pulmonary complications after lung and esophagus surgery were relatively low . The addition of IS to PT did not further reduce pulmonary complications or hospital stay . Although we can not rule out beneficial effects in a subgroup of high‐risk patients , routine use of IS after thoracic surgery seems to be ineffective BACKGROUND Pulmonary rehabilitation ( PR ) is proposed as an effective strategy to decrease surgical morbidity . However , appropriate rehabilitation plan , initiation time , and optimal duration of PR remain unclear . Lung cancer patients with chronic obstructive pulmonary disease ( COPD ) are considered high-risk population for postoperative pulmonary complications ( PPCs ) because of poor lung fitness and cardiopulmonary endurance . This study aims to assess the impact of a one-week , systematic and highly-intensive rehabilitation on surgical lung cancer patients with mild to moderate COPD . METHODS A r and omized controlled trial with 48 subjects was conducted ( 24 patients each for the intervention and groups ) . The intervention group received seven days of systematic , integrated and highly-intensive PR before surgical treatment , including : pharmacotherapy with atomizing terbutaline , pulmicort and infusion of ambroxol ; and physical rehabilitation with respiratory training and endurance training . The control group underwent st and ard preoperative care . RESULTS For the intervention group , the postoperative length of stay was shorter [ ( 6.17±2.91 ) d vs ( 8.08±2.21 ) d ; P=0.013 ] ; likewise for the duration of antibiotics use [ ( 3.61±2.53 ) d vs ( 5.36±3.12 ) d ; P=0.032 ] . No significant difference was found between the groups in total in-hospital cost [ ( 46,455.6±5,080.9 ) ¥ vs ( 45,536.0±4,195.8 ) ¥ , P=0.498 ] , medicine cost [ ( 7,760.3±2,366.0 ) vs ( 6,993.0±2,022.5 ) , P=0.223 ] , and material cost [ ( 21,155.5±10,512.1 ) ¥ vs ( 21,488.8±3,470.6 ) ¥ , P=0.883 ] . In the intervention group , peak expiratory flow [ ( 268.40±123.94 ) L/min vs ( 343.71±123.92 ) L/min ; P<0.001 ] , 6-min walk distance ( 6-MWD ) [ ( 595.42±106.74 ) m vs ( 620.90±99.27 ) m ; P=0.004 ] , and energy consumption [ ( 59.93±10.61 ) kcal vs ( 61.03±10.47 ) kcal ; P=0.004 ] were statistically different after the seven-day exercise , compared with those on the first day . Finally , for the intervention group the incidence of PPCs ( 8.3 % , 2/24 vs 20.8 % , 5/24 , 20.8 % ; P=0.416 ) were lower . CONCLUSIONS The systematic and highly-intensive pulmonary rehabilitation combining abdominal respiration training , respiratory exercise with incentive spirometry , and aerobic exercise could improve the cardiorespiratory endurance of lung cancer patients with mild to moderate COPD . The proposed program may be a practicable preoperative strategy . BACKGROUND AND PURPOSE The purpose of this study was to determine whether the addition of incentive spirometry ( IS ) to postoperative pulmonary physical therapy is more effective than physical therapy alone in reducing postoperative pulmonary complications in high-risk patients after coronary artery bypass grafting ( CABG ) . Patients were given the spirometer and instructed in its use , as often occurs in clinical setting s. SUBJECTS Patients with chronic airflow limitation following CABG ( N = 185 ) participated . METHODS Subjects were r and omly assigned to receive either postoperative pulmonary physical therapy ( breathing exercises , secretion removal , mobility ) or physical therapy combined with IS . RESULTS No difference was found between the two groups in atelectasis , spirometry , oxygen saturation , pulmonary infection , or hospital stay . CONCLUSION AND DISCUSSION Incentive spirometry combined with physical therapy is no more effective than postoperative physical therapy alone in reducing atelectasis for this population . Use of the spirometer , however , was not monitored , and although the study mimicked practice as it often occurs , the effectiveness of the spirometer can not be fully evaluated We entered 876 patients into a clinical trial aim ed at preventing pulmonary complications after abdominal surgery . Patients either received conventional chest physiotherapy or were encouraged to perform maximal inspiratory manoeuvres for 5 min during each hour while awake , using an incentive spirometer . The incidence of pulmonary complications did not differ significantly between the groups : incentive spirometry 68 of 431 ( 15.8 % , 95 % CI 14.0 - 17.6 % ) , and chest physiotherapy 68 of 445 ( 15.3 % , CI 13.6 - 17.0 % ) . Nor was there a difference between the groups in the incidence of positive clinical signs , pyrexia , abnormal chest radiographs , pathogens in sputum , respiratory failure ( PO2 less than 60 mm Hg ) , or length of stay in hospital . We conclude that prophylactic incentive spirometry and chest physiotherapy are of equivalent clinical efficacy in the general management of patients undergoing abdominal surgery Following cardiac operations , 145 patients were treated with either intermittent positive-pressure breathing ( IPPB ) , blod bottles , or an incentive spirometer in an attempt to alter the incidence of atelectasis . Pulmonary complications occurred in 30 % of the patients receiving IPPB , 15 % of those using an incentive spirometer , and 8 % of those using blow bottles .  Gastrointestinal side-effects occurred in 20 % of the IPPB group and were rare in other groups . The cost of IPPB is also considerably greater than either incentive spirometry or blow bottles . IPPB is not essential to prevention of atelectasis in postoperative cardiac surgical patients and may be inferior to other methods BACKGROUND This study was design ed to determine the incidence of thoracic bone infa rct ion in patients with sickle cell diseases who were hospitalized with acute chest or back pain above the diaphragm and to test the hypothesis that incentive spirometry can decrease the incidence of atelectasis and pulmonary infiltrates . METHODS We conducted a prospect i ve , r and omized trial in 29 patients between 8 and 21 years of age with sickle cell diseases who had 38 episodes of acute chest or back pain above the diaphragm and were hospitalized . Each episode of pain was considered to be an independent event . At each hospitalization , patients with normal or unchanged chest radiographs on admission were r and omly assigned to treatment with spirometry or to a control nonspirometry group . Each patient in the spirometry group took 10 maximal inspirations using an incentive spirometer every two hours between 8 a.m. and 10 p.m. and while awake during the night until the chest pain subsided . A second radiograph was obtained three or more days after admission , or sooner if clinical ly necessary , to determine the incidence of pulmonary complications . Bone scanning was performed no sooner than two days after hospital admission to determine the incidence of thoracic bone infa rct ion . RESULTS The incidence of thoracic bone infa rct ion was 39.5 percent ( 15 of 38 hospitalizations ) . Pulmonary complications ( atelectasis or infiltrates ) developed during only 1 of 19 hospitalizations of patients assigned to the spirometry group , as compared with 8 of 19 hospitalizations of patients in the nonspirometry group ( P = 0.019 ) . Among patients with thoracic bone infa rct ion , no pulmonary complications developed in those assigned to the spirometry group during a total of seven hospitalizations , whereas they developed during five of eight hospitalizations in the nonspirometry group ( P = 0.025 ) . CONCLUSIONS Thoracic bone infa rct ion is common in patients with sickle cell diseases who are hospitalized with acute chest pain .  Incentive spirometry can prevent the pulmonary complications ( atelectasis and infiltrates ) associated with the acute chest syndrome in patients with sickle cell diseases who are hospitalized with chest or back pain above the diaphragm OBJECTIVE Pulmonary complications are common after abdominal surgery .  Although a variety of risk factors have been described for these complications , studies so far have focused on elective interventions . The aim of this study was to determine the incidence and predictors of pulmonary complications following  emergency abdominal surgery .  METHODS This was a prospect i ve cohort study . Pre and intra-operative data were collected through interview and chart review and their association with the occurrence of postoperative pulmonary complications ( PPC ) were analyzed . RESULTS Two hundred and sixty-six consecutive adult patients were included and seventy-five ( 28.2 % ) developed PPC . Age > 50 years ( adjusted OR=3.86 ; P<0.001 ) , body mass index ( BMI ) < 21 kg/m(2 ) or 30 kg/m(2 ) ( adjusted OR=2.43 ; P=0.007 ) and upper or upper/lower abdominal incision ( adjusted OR=2.57 ; P=0.027 ) were independently associated with PPC . Patients su bmi tted to multiple procedures tended to be at a higher risk for PPC ( adjusted OR=1.73 ; P=0.079 ) . The development of PPC was associated with prolonged hospital stay ( P<0.001 ) and increased death rate ( P<0.001 ) . CONCLUSIONS Pulmonary complications are frequent among patients undergoing abdominal emergency surgery  and lead to increased length of hospital stay and death rate . Older age , abnormal BMI , upper or upper/lower abdominal incision and multiple procedures are predictors of PPC in this setting We have studied the efficacy of routine use of incentive spirometry ( IS ) in two groups of patients : group 1 ( n = 18 ) with IS , and group 2 ( n = 19 ) , no IS . All patients suffered from lung or esophagus neoplasm and received respiratory physiotherapy before and after the operation . They underwent high chest and abdomen surgery .  The incidence of alterations of pulmonary auscultation , roentgenologic abnormalities and alterations of the alveolar-arterial difference of oxygen ( D[A-a]O2 ) as well as postoperative complications were similar in both groups . Patients undergoing digestive surgery  presented a higher frequency of pleural effusion ( p less than 0.05 ) and of them , the subgroup with IS stayed at the hospital for a longer time ( 47.2 + /- 32 days ) than the subgroup undergoing digestive surgery not su bmi tted to IS ( p less than 0.01 ) probably because of the higher incidence of neoplasms of the mean third of the esophagus in such group . In our study and in the context of the type of surgery studied , the routine use of IS does not decrease the frequency of clinical and roentgenologic alterations neither improves the efficacy of postoperative gas interchange OBJECTIVES The goal of this study was to assess the impact of a preoperative 1-week , systematic , high-intensity inpatient exercise regimen on patients with lung cancer who had risk factors for postoperative pulmonary complications ( PPCs ) . METHODS We conducted a r and omized controlled trial with 101 subjects of a preoperative , 7-day systematic , integrated , high-intensity pulmonary exercise regimen .  The control group received st and ard preoperative care . We analysed the occurrence of PPCs in both groups as the primary outcome ; other outcomes included changes in blood gas , quality of life , peak expiratory flow rate , the 6-min walk distance and others . RESULTS The 6-min walk distance showed an increase of 22.9 ± 25.9 m in the intervention group compared with 4.2 ± 9.2 m in the control group , giving a between-group difference of 18.7 m ( 95 % confidence interval : 8.8 - 28.6 ; P < 0.001 ) ; the peak expiratory flow increased by 25.2 ± 24.6 l/min , compared with 4.2 ± 7.7 l/min ( between-group difference : 21.0 m , 95 % confidence interval : 7.2 - 34.8 ; P = 0.003 ) . The intervention group had a shorter average total ( 15.6 ± 3.6 vs 17.7 ± 5.3 days , P = 0.023 ) and postoperative length of stay ( 6.1 ± 3.0 vs 8.7 ± 4.6 days , P = 0.001 ) than the control group ; the incidence of PPCs ( 9.8 % , 5/51 vs 28.0 % , 14/50 , P = 0.019 ) was significantly lower . A multivariable analysis of the risk of PPCs identified short-term rehabilitation intervention to be an independent risk factor ( odds ratio = 0.156 , 95 % confidence interval : 0.037 - 0.649 , P = 0.011 ) . CONCLUSIONS The study results suggested that a systematic , high-intensity pulmonary exercise programme was a practical strategy when performed preoperatively in patients with lung cancer with risk factors for PPCs . CLINICAL TRIAL REGISTRATION ChiCTR-IOR-16008109 Abdominal binders are ordered by some surgeons postoperatively for patient comfort and to prevent wound complications . There has been some question as to the compressive effect that an abdominal binder has on pulmonary function . We prospect ively r and omized 54 patients undergoing a midline laparotomy incision to two groups : a “ binder ” group and a “ no binder ” group .  Preoperative pulmonary function tests ( vital capacity and incentive spirometry ) were measured . Postoperatively , pulmonary function tests , pulse oximetry , oxygen requirement , pulmonary and wound complications , pain control , time to ambulation , and hospital length of stay were examined . Vital capacity as a per cent of preoperative values on postoperative Day 1 for the binder and nonbinder groups were 64.7 and 54.6 per cent , respectively , but this was not statistically significant . Average level of pain using the visual analog pain scale on postoperative Days 1 through 3 in the binder versus nonbinder groups was 4 versus 8 , 3 vs 6 , and 3 versus 7 , respectively . Time to ambulation was 18.6 hours in the binder group and 16.7 hours in the nonbinder group . Hospital length of stay in the binder and nonbinder groups was 3.9 days and 3.7 days , respectively . We conclude that abdominal binders in our patients with midline abdominal incisions had no significant effect on postoperative pulmonary function , but seemed to help with pain control Of 38 patients undergoing median sternotomy for cardiac operations all developed profound restrictive defects in pulmonary function during the first 72 h after tracheal extubation . Although decreased lung volumes were refractory to correction by vigorous , aggressive pulmonary therapy during this period , frequent and supervised treatment may prevent further deterioration in pulmonary function . The overall incidence of pneumonia was only 3 % ( 1/38 ) . Continuous positive airway pressure delivered by mask proved to be a nearly effortless form of postoperative respiratory therapy that was less painful than incentive spirometry or coughing and deep breathing , and therefore may be preferable Objective : The aim of this article was to study the prevalence and significance of sarcopenia in the multimodal management of locally advanced esophageal cancer ( LAEC ) , and to assess its independent impact on operative and oncologic outcomes . Summary of Background Data : Sarcopenia in cancer may confer negative outcomes , but its prevalence and impact on modern multimodal regimens for LAEC have not been systematic ally studied . Methods : Two hundred fifty-two consecutive patients were studied .  Lean body mass ( LBM ) , skeletal muscle index ( SMI ) , and fat mass ( FM ) were determined pre-treatment , preoperatively , and 1 year postoperatively . Sarcopenia was defined by computed tomography ( CT ) at L3 as SMI < 52.4 cm2/m2 for males and SMI < 38.5 cm2/m2 for females . All complications were recorded prospect ively , including comprehensive complications index ( CCI ) , Clavien-Dindo complication ( CDC ) , and pulmonary complications ( PPCs ) . Multivariable linear , logistic , and Cox regression analysis was performed . Results : In-hospital mortality was 1 % , and CCI was 21 ± 19 . Sarcopenia increased ( P = 0.02 ) from 16 % at diagnosis to 31 % post-neoadjuvant therapy , with loss of LBM ( -3.0 ± 5.4 kg , P < 0.0001 ) , but not FM ( -0.3 ± 2.7 kg , P= 0.31 ) during treatment . On multivariable analysis , preoperative sarcopenia was associated with CCI ( P = 0.043 ) , and CDC ≥IIIb ( P = 0.003 ) . PPCs occurred in 36 % nonsarcopenic versus 55 % sarcopenic patients ( P = 0.01 ) . Sarcopenia did not impact disease-specific ( P = 0.14 ) or overall survival ( P = 0.11 ) after resection . At 1 year , 35 % had sarcopenia , significantly associated with pre-treatment BMI ( P = 0.013 ) but not complications ( P = 0.20 ) . Conclusions : Sarcopenia increases through multimodal therapy , is associated with an increased risk of major postoperative complications , and is prevalent in survivorship . These data highlight a potentially modifiable marker of risk that should be assessed and targeted in modern multimodal care pathways Abstract Objective : To evaluate the prevention of respiratory complications after abdominal surgery by a comparison of a global policy of incentive spirometry with a regimen consisting of deep breathing exercises for low risk patients and incentive spirometry plus physiotherapy  for high risk patients . Design : Stratified r and omised trial . Setting : General surgical service of an urban teaching hospital . Patients : 456 patients undergoing abdominal surgery . Patients less than 60 years of age with an American Society of Anesthesia classification of 1 were considered to be at low risk . Outcome measures : Respiratory complications were defined as clinical features consistent with collapse or consolidation , a temperature above 38 ° C , plus either confirmatory chest radiology or positive results on sputum microbiology . We also recorded the time that staff devoted to prophylactic respiratory therapy . Results : There was good baseline equivalence between the groups . The incidence of respiratory complications was 15 % ( 35/231 ) for patients in the incentive spirometry group and 12 % ( 28/225 ) for patients in the mixed therapy group ( P=0.40 ; 95 % confidence interval -3.6 % to 9.0 % ) . It required similar amounts of staff time to provide incentive spirometry and deep breathing exercises for low risk patients . The inclusion of physiotherapy for high risk patients , however , result ed in the utilisation of an extra 30 minutes of staff time per patient . Conclusions : When the use of re sources is taken into account , the most efficient regimen of prophylaxis against respiratory complications after abdominal surgery is deep breathing exercises for low risk patients and incentive spirometry for high risk patients . Key messages Key messages Most postoperative respiratory complications were due to atelectasis : less than 1 % of the patients developed pneumonia An American Society of Anesthesia classification > 1 and an age > /=60 years is a simple way of defining patients at high risk of respiratory complications and other adverse events after abdominal surgery A regimen consisting of deep breathing exercises ( low risk patients ) and incentive spirometry ( high risk patients ) is an efficient way of providing prophylaxis against respiratory complications after abdominal CONTEXT Postoperative pulmonary complications ( PPCs ) after coronary artery bypass graft ( CABG ) surgery are a major source of morbidity and mortality , and increase length of hospital stay and re source utilization . The prehospitalization period before CABG surgery may be used to improve a patient 's pulmonary condition . The efficacy of preoperative inspiratory muscle training ( IMT ) in reducing the incidence of PPCs in high-risk patients undergoing CABG surgery has not yet been determined . OBJECTIVE To evaluate the prophylactic efficacy of preoperative IMT on the incidence of PPCs in high-risk patients scheduled for elective CABG surgery . DESIGN , SETTING , AND PATIENTS A single-blind , r and omized clinical trial conducted at the University Medical Center Utrecht , Utrecht , the Netherl and s , with enrollment between July 2002 and August 2005 . Of 655 patients referred for elective CABG surgery , 299 ( 45.6 % ) met criteria for high risk of developing PPCs , of whom 279 were enrolled and followed up until discharge from hospital . INTERVENTION Patients were r and omly assigned to receive either preoperative IMT ( n = 140 ) or usual care ( n = 139 ) . Both groups received the same postoperative physical therapy . MAIN OUTCOME MEASURES Incidence of PPCs , especially pneumonia , and duration of postoperative hospitalization . RESULTS Both groups were comparable at baseline . After CABG surgery , PPCs were present in 25 ( 18.0 % ) of 139 patients in the IMT group and 48 ( 35.0 % ) of 137 patients in the usual care group ( odds ratio [ OR ] , 0.52 ; 95 % confidence interval [ CI ] , 0.30 - 0.92 ) . Pneumonia occurred in 9 ( 6.5 % ) of 139 patients in the IMT group and in 22 ( 16.1 % ) of 137 patients in the usual care group ( OR , 0.40 ; 95 % CI , 0.19 - 0.84 ) . Median duration of postoperative hospitalization was 7 days ( range , 5 - 41 days ) in the IMT group vs 8 days ( range , 6 - 70 days ) in the usual care group by Mann-Whitney U statistic ( z = -2.42 ; P = .02 ) . CONCLUSION Preoperative IMT reduced the incidence of PPCs and duration of postoperative hospitalization in patients at high risk of developing a pulmonary complication undergoing CABG surgery . TRIAL REGISTRATION is rct n.org Identifier : IS RCT N17691887 Background Postoperative pulmonary complications ( PPC ) are the most frequently observed complications following lung resection , of which pneumonia and atelectasis are the most common . PPCs have a significant clinical and economic impact associated with increased observed number of deaths , morbidity , length of stay and associated cost . The aim of this study was to assess the incidence and impact of PPCs and to identify potentially modifiable independent risk factors . Methods A prospect i ve observational study was carried out on all patients following lung resection via thoracotomy in a regional thoracic centre over 13 months .  PPC was assessed using a scoring system based on chest x-ray , raised white cell count , fever , microbiology , purulent sputum and oxygen saturations . Results Thirty-four of 234 subjects ( 14.5 % ) had clinical evidence of PPC . The PPC patient group had a significantly longer length of stay ( LOS ) in hospital , high dependency unit ( HDU ) LOS , higher frequency of intensive care unit ( ITU ) admission and a higher number of hospital deaths . Older patients , body mass index ( BMI ) ≥30 kg/m2 , preoperative activity < 400 m , American Society of Anesthesiologists ( ASA ) score ≥3 , smoking history , chronic obstructive pulmonary disease ( COPD ) , lower preoperative forced expiratory volume in 1 s ( FEV1 ) and predicted postoperative ( PPO ) FEV1 were all significantly ( p<0.05 ) associated with PPC on univariate analysis . Multivariate analysis confirmed that age > 75 years , BMI ≥30 kg/m2 , ASA ≥3 , smoking history and COPD were significant independent risk factors in the development of PPC ( p<0.05 ) . Conclusion The clinical impact of PPCs is marked . Significant independent preoperative risk factors have been identified in current clinical practice . Potentially modifiable risk factors include BMI , smoking status and COPD . The impact of targeted therapy requires further evaluation The effect of three postoperative regimes of respiratory therapy on  pulmonary complications and lung function was compared in high‐risk patients . Fifty‐one patients were r and omized to : 1 ) conventional chest physiotherapy alone ( PHYS ) , 2 ) chest physiotherapy and positive expiratory pressure ( PEP ) , or 3 ) chest physiotherapy with both positive expiratory pressure and inspiratory resistance ( RMT ) . Treatments were given twice daily by a physiotherapist and self‐administered . The incidence of postoperative pulmonary complications ( PPC ) was respectively , 71 % , 76 % and 65 % in the PHYS‐ , PEP‐ and RMT‐groups . The incidence of PPC requiring treatment with antibiotic , bronchodilator or supplementary oxygen according to the existing clinical practice was 47 % , 47 % and 29 % . The incidence of atelectasis was 65 % , 64 % and 60 % and of pneumonia 29 % , 35 % and 6 % . There was no difference between the groups , except for a tendency to a lower frequency of pneumonia in the RMT‐group . Postoperatively forced vital capacity ( FVC ) decreased to mean 54 % , forced expired volume in 1 s to 48 % and functional residual capacity to 76 % of preoperative values . Arterial oxygen tension ( Pao2 ) declined to mean 8.1 kPa and arterial saturation ( Sao2 ) to 89 % . There was no difference between the groups except for FVC , Pao2 and Sao2 ( P = 0.008 , P = 0.008 and P = 0.002 ) , which showed the least decrease in the RMT‐group . None of the regimens could be considered as satisfactory concerning the prevention of PPC , but RMT seemed to be the most efficient . Insufficient self‐administration of treatment was probably one of the causes of the overall high incidence of PPC in this study
Presently , the evidence does not support the use of IS for decreasing the incidence of PPCs following cardiac or upper abdominal surgery
OBJECTIVE To systematic ally review the evidence examining the use of incentive spirometry ( IS ) for the prevention of  postoperative pulmonary complications ( PPCs ) .