Incentive Spirometry Added to Physiotherapy to Reduce Postoperative Pulmonary Complications After Lung Surgery

Study Overview
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Brief Summary
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After any surgery, there is a chance of complications. After lung surgery to remove tumours, there is a particularly high chance of a person developing an infection or needing help breathing, called post operative pulmonary complications. Currently, the risk of these complications is reduced through the completion of light physical and deep breathing exercises and walking around as soon as possible after surgery. Another possible way of helping these patients is to use a small device called an Incentive Spirometer to encourage and measure deep breathing. This study wants to compare how often postoperative pulmonary complications happen after major lung surgery between a group completing the exercises alone and a group using the Incentive spirometer in addition to the exercises. It is hoped that the combined therapy will reduce the amount of time patient must stay in hospital, have fewer complication events and have fewer patients re-admitted back into the hospital after they go home, so that patients overall have better outcomes.

Detailed Description
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This study is a prospective blinded randomized control trial (RCT) where two arms will be assembled. Consenting eligible patients will be randomized to either the physiotherapy + incentive spirometry (PT+IS-intervention) arm or physiotherapy only (PT-control arm). Patients will be randomized with an equal (1:1) chance of being allocated to either the PT (control) arm or PT+IS (intervention) arm. Both the treating surgeon and data interpreter will be blinded to the intervention.

Official Title
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Incentive Spirometry Added to Physiotherapy to Reduce Postoperative Pulmonary Complications After Lung Surgery: A Prospective Blinded Randomized Trial

Conditions
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Lung Neoplasms, Benign Lung Disease

Intervention / Treatment
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* Procedure: Incentive spirometry
* Other: Physiotherapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients must be at minimum age 18 Patient must be undergoing pulmonary resection surgery for malignant or benign disease Patients must be able to understand English Patients must be able to demonstrate aptitude and willingness to comply with describes study procedures Exclusion Criteria: Patients who are unable to read and communicate in English Home oxygen usage prior to operation Previous pulmonary resection or any thoracic surgery Radiological evidence of atelectasis or pneumonitis on preoperative imaging Radiological evidence of pleural effusion prior on preoperative imaging Prior exposure to pulmonotoxic drugs such as amiodarone or belomycin Current drug or alcohol use or dependence that, in the opinion of the site investigator, would interfere with adherence to study requirements. Inability or unwillingness of individual or legal guardian/representative to give written informed consent

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Standard physiotherapy<br>Standard physiotherapy includes routine physiotherapy care as per current institutional standards. This consists of two daily visits by the physiotherapist. During the visits, the patient will be taught deep breathing and will be instructed to practice it 10 times every hour. They are also shown shoulder movements and lung expansion exercises. They will receive a sheet summarizing the exercises for future reference. The patient is discharged from physiotherapy when they are ambulatory, on room air, and able to clear their respiratory secretions independently, although they will be asked to continue the exercises on their own until 30 days from surgery. | Other: Physiotherapy<br>* Standard of care exercise training and supervision<br>|
| Experimental: Incentive Spirometry<br>Patients in the Incentive Spirometry arm will receive standard physiotherapy care in addition to training and use of an incentive spirometer. The physiotherapy care includes routine care as per current institutional standards. They will also receive an incentive spirometer on the first postoperative day and will be taught how to use it with an accompanying instructional sheet for later reference. Teaching will emphasize slow deep breathing, sustained vacuum pressure, and gradual increase in difficulty. Patients will be instructed to use the spirometer 10 times every hour until 30 days after surgery. | Procedure: Incentive spirometry<br> <br> Other: Physiotherapy<br>* Standard of care exercise training and supervision<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Rate of post operative pulmonary complications within 30 days of surgery | Postoperative pulmonary complications (PPCs) are defined as: Pneumonia requiring treatment with antibiotics Atelectasis requiring pulmonary toilet by bronchoscopy Respiratory failure requiring treatment via mechanical ventilation (invasive or non-invasive) Requirement for home oxygen after surgery, when this was not the case prior to surgery | 30 days after surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Duration of oxygen treatment in hospital | Use of oxygen therapy required while in hospital | 30 days post-surgery | 
| Length of hospital stay |  | 30 days after surgery | 
| Re-admission to hospital | Re-admission to hospital due to post operative pulmonary complications | 30 days | 
| Cost effectiveness of spirometry utilization | Calculated as an aggregate measure considering length of hospital stay, readmission to hospital and cost of treating complications. A cost value will be assigned to each group and compared for cost-benefit relationships | 30 days after surgery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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lung resection, incentive spirometry, physiotherapy, quality improvement, outcomes, post operative complications