The Effects Incentive Spirometry Use in Coronary Artery Bypass Surgery
Condition: Incentive Spirometry; Oxygen Saturation
Study type: Interventional

Summary: 
      Aims and objectives: The aims of this study is to determine the effect of incentive
      spirometry on arterial blood gas and venous oxygen saturation and vital signs, in addition to
      pulmonary rehabilitation care before and after coronary artery bypass graft surgery. The
      objectives; were to accelerate the healing process by reducing pulmonary complications.

      Background: Nurses, who carry much of the responsibility for the basic care of patients
      surgery play a highly important role. As a result of strong care, the recovery process of the
      patients will be accelerated, the hospitalization period will be shortened and morbidity and
      mortality will be prevented.

      Design and Methods: Included in this randomized controlled study were 32 patients who
      underwent coronary arterial bypass graft surgery (16 in experimental group; 16 in control
      group) in a university hospital. Incentive spirometry is applied in the study along with an
      identified inspiration technique and an expiration technique that has not been previously
      encountered in literature. The preoperative measured values of the patients were compared
      with the arterial blood gas and venous oxygen saturation values and vital signs on the first,
      second and third postoperative days. In this study, the CONSORT checklist was followed.
    

Detailed description: 
      METHODS Design The patients in this dual-group, quasi-experimental randomized controlled
      study were divided into control and experimental groups using a block randomization method.

      Study sample This study consisted of 32 patients (16 in the experimental group; 16 in the
      study group) who were hospitalized in the cardiovascular surgery clinic of a university
      hospital and underwent Coronary Artery Bypass Graft (CABG) surgery between December 2019 and
      February 2020. As a result of the power analysis using the G*Power 3.0.10 program with the
      data obtained from the research; the power of the study was found to be 85% for f=0.2251
      effect size, 5% margin of error and n=32 sample number.

      Data collection "Personal Information" and "Application Information" forms prepared by the
      researcher were used for the collection of data. The Personal Information Form (PIF) was
      prepared by the researcher after a review of previous studies, and included questions about
      age, body mass index (BMI), gender, chronic disease, alcohol and cigarette use, physical
      exercise, diet and American Society of Anesthesiologists (ASA) classification. The last
      preoperative arterial blood gas value, the values from the first, second and third
      postoperative days, as well as the venous oxygen saturation values and vital signs, were
      recorded on the application information form. Written informed consent was obtained from all
      the patients after they were explained the purpose of the study, and all took part in
      face-to-face interviews for the garnering of data.

      Incentive Spirometry (IS) is designed to mimic the natural sighing or yawning maneuvers. The
      technique was used with a deep inspiration focus, as described previously in literature.
      Unlike in previous studies, IS was used in the present study not only for inspiration but
      also for expiration. In normal use, IS involves the raising of three balls side by side in
      transparent plastic tubes during each deep inspiration, but when turned upside down, the
      device can be applied also to expiration. It is thus possible to use the IS with both
      inspiration and expiration techniques, with positive effects on the patient in both uses. The
      present study made use of flow-focused IS with both the inspiration and expiration
      techniques, in addition to such routine clinical procedures as breathing exercises, coughing
      exercises, early mobilization and pain control.

      The ethical aspect of the study Ethics committee approval (Date: 28.12.2017 Reference Number:
      72 Decision Number: 8) was granted by the Non-Invasive Clinical Research Ethics Committee and
      the necessary institutional permissions were obtained from the hospital in which the research
      was conducted. The study was carried out in compliance with the principles of the Declaration
      of Helsinki, as revised in 2008. The patients included in the study were informed about the
      study, the aim of the study was explained, and their verbal and written consent for
      participation in the study was obtained.

      Statistical analysis The Statistical Package for the Social Sciences (SPSS) Statistics
      (Version 24.0) package program was used for the statistical analyses. Frequency tables and
      descriptive statistics were used for the interpretation of the findings. Parametric methods
      were used for measurement values with a normal distribution. In accordance with parametric
      methods, the measurement values of two independent groups were compared with an Independent
      Sample t test (t-table value) and the measurement values of three or more dependent groups
      were compared with a Repeated Measures test (F-table value). Non-parametric methods were used
      for normally distributed measurement values. In accordance with non-parametric methods, the
      measurement values of two independent groups were compared with a Mann-Whitney U test
      (Z-table value) and the measurement values of three or more dependent groups were compared
      with a Friedman test (χ2-table value). Pearson-χ2 crossbars were used for the examination of
      the relationships between two qualitative variables. Consolidated Standards of Reporting
      Trials (CONSORT) checklist, guidelines for reporting of randomized controlled trials were
      used as the reporting guideline for this study.
    

Intervention name(s): Incentive Spirometry Group
Intervention type(s): Procedure
Intervention description(s): The inspiration and expiration applications of incentive spirometry (IS) involved 10-20 breaths every one to two hours, depending on the tolerance of the patients.
During the inspiration application of IS, the head of the bed was elevated to a 45° angle, and the patient was placed in a long sitting position. The patient was requested to surround and fix the IS mouthpiece well, ensuring no gap was left between the lips. The patient was told to breathe slowly and deeply, and was asked to hold their breath for 2-3 seconds, and then to breathe normally with the IS mouthpiece in his/her mouth. The patient was advised to repeat the exercise 5-10 times, and to try to cough after every 5 exercises.
For the applied IS expiration technique applied in the study, which had not been previously encountered in literature, the patient was requested to turn the IS upside down (clockwise,180°) and to place the mouthpiece in his/her mouth and expiration application it.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Prevention
Keywords: Vital Signs; Coronary Heart Disease; Post-operative Care; Practice Nursing; Respiratory Nursing; Surgical Nursing