Using Pre-op Incentive Spirometer Reduces Chances of Basal Atelectasis in Patients Undergoing Upper Abdominal Surgeries
Condition: Cholelithiasis; Epigastric Hernia; Duodenal Perforation
MeSH terms: Cholelithiasis; Cholecystolithiasis; Gallstones
Study type: Interventional

Summary: 
      ABSTRACT Objective: To compare frequency of basal atelectasis in patients undergoing upper
      abdominal surgery who are provided pre-operative incentive spirometry versus those not
      provided pre-operative incentive spirometry
    

Detailed description: 
      After patient selection through "non-probability consecutive sampling" Investigator recorded
      baseline characteristics of our patients including age, gender and body mass index (BMI).
      Once recorded, patients will be randomly divided into two equal groups (each containing 37
      patients). In group A or "incentive spirometry group" patients were directed to start
      incentive spirometry, 48 hours prior to surgery. They were given an incentive spirometer and
      were briefed that they should inhale into the mouth piece of spirometer to lift the balls to
      the roof of tube and hold for five seconds and then exhale. 13 They were asked to perform 10
      such breaths for 6 times in a day till surgery under direct supervision of researcher and
      this was charted in patient file. In group B or "no incentive spirometry group" patients were
      not asked to perform incentive spirometry.

      After this, all the included patients underwent upper abdominal surgery by expert surgical
      team under general anesthesia. Type of surgery (Laparoscopic Cholecystectomy / Open
      Cholecystectomy / perforated duodenal repair/ Epigastric Hernia Repair / Gastrojejunostomy)
      and duration for which patient was on ventilator support (in minutes) was documented. After
      surgery, all the patients were given adequate analgesia and antibiotics as per standard
      hospital protocol. Patients were assessed at 48 hours after surgery for presence of basal
      atelectasis which will be diagnosed clinically by presence of new onset respiratory symptoms
      "cough, crackles, tachypnea and reduced breath sounds at bases" and by chest X-ray "presence
      of basal opacification, crowded air bronchograms, crowded pulmonary vasculature and
      compensatory hyper-expansion of surrounding unaffected lung".

      "The statistical package for social sciences (SPSS) version 22 software was used for
      statistical analysis of the data. Normality of test will be checked using Shapiro-Wilk test
      which showed that age and BMI were normally distributed while duration of ventilatory support
      was non-normal data. For qualitative variables frequency and percentages were used, whereas
      for quantitative data mean ± standard deviation and median (IQR) were used. Qualitative
      variables (gender, type of surgery and presence of basal atelectasis) were compared between
      groups with the use of chi-square test. Quantitative variable (age and BMI) were compared
      between groups using Student t-test while (duration of ventilatory support) were compared
      between groups using Mann-Whittney U-test. A p-value of ≤ 0.05 was considered significant".
    

Intervention name(s): Pre-Op Incentive Spirometer
Intervention type(s): Device
Intervention description(s): incentive spirometry group" patients were directed to start incentive spirometry, 48 hours prior to surgery. They were given an incentive spirometer and were briefed that they should inhale into the mouth piece of spirometer to lift the balls to the roof of tube and hold for five seconds and then exhale. 13 They were asked to perform 10 such breaths for 6 times in a day till surgery under direct supervision of researcher and this was charted in patient file.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Abdominal Surgery; Atelectasis; Incentive spirometry