The Effectiveness of Incentive Spirometry Training During the Physiotherapy Management of Atelectasis: A Case Report
Monisha R1, TS Muthukumar2* and K Amutha2
1Assistant Professor, SRM College of Physiotherapy, India
2Professor, Sri Ramakrishna College of Physiotherapy, India
Submission: June 01, 2018;Published: July 18, 2018
*Corresponding author: TS Muthukumar, Professor, Sri Ramakrishna College of Physiotherapy, India, Email: firstname.lastname@example.org
How to cite this article: Monisha R, TS Muthukumar, K Amutha. The Effectiveness of Incentive Spirometry Training During the Physiotherapy
Management of Atelectasis: A Case Report. J Yoga & Physio. 2018; 5(4): 555670. DOI:10.19080/JYP.2018.05.555670
Atelectasis is commonly reported as one of the post operative complication in patients with lung and abdominal surgeries. If the post operative complications are left untreated after the surgery, it can lead to infections and fibrosis at later stage. The effectiveness of incentive spirometer training in addition to the respiratory physiotherapy management can help prevent atelectasis and it is one of the gold standard methods in reducing the post operative lung complication and helps re-expand the collapsed lung, there by improves oxygenation and helps to clear the airways. This case report was done to find out the effectiveness of incentive spirometer as a expiratory and inspiratory muscle trainer managing patients with post operative lung complication.
Pulmonary complications are common in patients with pre-operative respiratory complications. However, previous researchers have emphasized the importance of pre-operative respiratory physiotherapy in the management of post operative lung complications.
But the importance of incentive spirometer training as a inspiratory and expiratory muscle training source has not paid much attention by the researchers and also its beneficial effects in the pre-operative and post operative respiratory physiotherapy management has not been done in the patients receiving bed-side physiotherapy treatment in the daily routine. Atelectasis is more common among patients undergoing abdominal and lung surgeries without receiving the pre-operative respiratory therapy. They have a reduction in FRC, ventilation-perfusion mismatching is more pronounced in patients presented in the post operative day 1. If incentive spirometer training has not been delivered in patients with lung complication.
Several research protocols have been published evaluating the role of physio-therapist in the intensive care unit (ICU). The primary objective of physiotherapy management in ICU is to prevent respiratory complications and to oxygenation. The effectiveness of incentive spirometer training in addition to respiratory physiotherapy management re-inflate collapsed lung and it also aids in removal of secretions. But none of the researcher have highlighted the importance of expiratory muscle training with the help of incentive spirometer.
Incentive spirometric is a device which provides a greater airway clearance and helps in improving oxygenation. This device assists in inflating the lungs with oxygen. Post transplantation procedures and post operative patients in ICU and patients underwent abdominal surgery have limitation in taking a deep breath, because of pain. Incentive spirometer training successfully recruits atelectasis lung segments by proving a resistance to inspiratory component of breathing. This is followed by an inspiratory pause of 2 seconds and a expiratory component has been trained by reversing this device. Leading to a rapid flow of air and it will simulate the cough.
A 44-year old male was admitted to the department of pulmonary medicine, on 1/09/2015, after diagnosed with exacerbation of COPD. He sustained severe dyspnoea in relation to BORG scale with resultant skeletal muscle dysfunction. Presented with Pectus excavatum and have right side- scoliosis, Chest examination revealed the patient has emphysematic bullae.
No referral was made to physiotherapy at this time of
admission. 2 weeks after admission the patient’s respiratory
complications were high and he suddenly developed severe
respiratory distress. The patient was intubated and his x ray
shows atelectasis in right and left lung lobes.
Following physiotherapy referrel, examination of the chest
x-ray revealed a total collapse of the right and left lung with the
endotracheal tube situated at level T2, his ABG results shows
hypoxaemia and respiratory acidosis.
The ventilation parameters were set at peak airway pressure
of 35cm H2O, positive end-expiratory pressure (PEEP) of 10cm
H2O, pressure support of 20cm H2O and a ventilation rate of 20
breaths/min and he was in pressure support mode. The patient
was in supine lying and Chest wall expansion has been assessed,
shows asymmetry in expansion with no expansion on the right
side as compared to left.
The first physiotherapy treatment session started at 9.00am.
The patient was positioned in left side lying, maintaining the
head elevation at 40º. Chest physiotherapy was applied to the
posterior and lateral segments of the right lung for 5 minutes
and the same maneuver has been repeated for left lung with
the patient positioned in right side lying. Thereafter incentive
spirometer training was performed by the patient and expiratory
muscle training was done followed by inspiratory training
with resistance provided in 600, 900 and 1200cc. components
of respiratory training circuit. Respiratory muscle training
was continued for 10 minutes. Then the therapist applied
chest wall shaking to the posterior and lateral lung segments
during expiration to facilitate optimal secretion clearance. The
treatment session lasted for 20 minutes and no changes in
cardiovascular status were noted throughout the treatment.
The assessment after the first treatment revealed that chest
wall expansion of right lung had improved significantly but
reduced expansion was still present in the left lung. Auscultation
revealed improved breath sounds in the right and left lower
The arterial blood gas results taken at 10:00, 12:00 and 16:00
on 1/09/2015 and for 08:00 and 10:00 on 2/09/2015 indicated
a marked improvement between the first two treatments was
documented. On physiotherapy assessment of the chest the
next day (2/09/2014), the chest wall symmetry improved and
auscultation revealed normal breath sounds throughout the
right and left lung with no added sounds as Table 1.
The use of manual chest physiotherapy with postural
drainage position proved to be beneficial to this patient with
regards to re-inflation of the col-lapsed lung and improved
oxygenation and ventilation. However, incentive spirometry
training has an added advantage of improving the respiratory
muscle strength. The cause of the atelectasis is speculated to
be aspiration. Many patients have sudden detoriation in the
ward as aspiration is an unexplained event happens in patients
with respiratory complication and much attention have been
needed for this patient population. At the time of writing this
case assessment (four weeks later), the patient had regained a
normal level of respiratory muscle functioning.
There is an improvement in oxygenation after the first
treatment and the resolution of the atelectasis of the right and
left lung within 20 hours, indicates the effective-ness of early
physiotherapy treatment for patients with atelectasis with the
help of incentive spirometer training. The findings of this case
report confirm results from previous studies regarding the
effectiveness of incentive spirometer as an adjunct to chest
physiotherapy treatment and the effectiveness of physiotherapy
management of patients with the help of incentive spirometer
training as expiratory muscle training device has been facilitated
in this study.