Effect of incentive spirometry after cardiac surgery: protocol for a systematic review
DOI:
https://doi.org/10.33233/fb.v21i1.3625Keywords:
incentive spirometry, cardiac surgery, post-operativeAbstract
Introduction: Patients receiving cardiac surgeries present high risk of developing postoperative complications. Incentive spirometry (IS) is used for the prevention and treatment of postoperative pulmonary complications in patients undergoing cardiac surgeries. Publications have suggested that IS is ineffective. In contrast, some studies have shown that when IS is adequately used, it may lead to beneficial outcomes. Objectives: To assess the effect of IS in patients undergoing cardiac surgeries. Methods/design: Systematic Reviews with randomised and quasi-randomised trials with adult patients undergoing cardiac surgeries, evaluating the effect of flow or volume-oriented IS. Outcome measures: postoperative pulmonary complications; adverse events; mortality; length of hospital stay; length of intensive care unit stay; reintubation rate; pulmonary function; antibiotic use; oxygenation; and respiratory muscle strength. Search: MEDLINE, EMBASE, CENTRAL, PEDro, CINAHL, LILACS, SCIELO, Allied, AMED, Scopus, Open Grey database, the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP), ClinicalTrials.gov, clinicaltrialsregister.eu, and ReBec. Two authors will independently extract data. PEDro scale will be used to evaluate the methodological quality of the studies. Meta-analysis will be performed using the inverse variance method and the random effects model in RevMan 5.3. We will use the I2 statistic to estimate the amount of heterogeneity across studies in each meta-analysis. Ethics and dissemination: The approval of an ethical committee is not required. Only clinical trials that have complied with ethical guidelines and followed the Declaration of Helsinki, will be included in this systematic review. The findings of this study will help clarify uncertainties about the effects of incentive spirometry in the postoperative period of cardiac surgery and may be disseminated to clinicians, assisting in decision making and including the best evidence in the treatment of their patients. Discussion: This review will clarify the uncertainty over whether IS is a useful technique for patients undergoing cardiac surgeries. While good quality studies have shown IS is an effective prophylactic technique, other studies have suggested that there is no evidence to support IS utilization.
References
Parikh CR, Coca SG, Thiessen-Philbrook H, Shlipak MG, Koyner JL, Wang Z et al. Postoperative biomarkers predict acute kidney injury and poor outcomes after adult cardiac surgery. J Am Soc Nephrol 2011;22(9):1748-57. doi: 10.1681/asn.2010121302
Ball L, Costantino F, Pelosi P. Postoperative complications of patients undergoing cardiac surgery. Curr Opin Crit Care 2016;22(4):386-92. doi: 10.1097/mcc.0000000000000319
Siregar S, Groenwold RH, de Mol BA, Speekenbrink RG, Versteegh MI, Brandon Bravo Bruinsma GJ et al. Evaluation of cardiac surgery mortality rates: 30-day mortality or longer follow-up? Eur J Cardiothorac Surg 2013;44(5):875-83. doi: 10.1093/ejcts/ezt119
Hansen LS, Hjortdal VE, Andreasen JJ, Mortensen PE, Jakobsen CJ. 30-day mortality after coronary artery bypass grafting and valve surgery has greatly improved over the last decade, but the 1-year mortality remains constant. Ann Card Anaesth 2015;18(2):138-42. doi: 10.4103/0971-9784.154462
Gelsomino S, Lorusso R, Livi U, Masullo G, Lucí F, Maessen J et al. Cost and cost-effectiveness of cardiac surgery in elderly patients. J Thorac Cardiovasc Surg 2011;142(5):1062-73. doi: 10.1016/j.jtcvs.2011.02.013
Leyva F, Qiu T, Evison F, Christoforou C, McNulty D, Ludman P et al. Clinical outcomes and costs of cardiac revascularisation in England and New York state. Open Heart 2018;5(1):e000704. doi: 10.1136/openhrt-2017-000704
Birkmeyer JD, Gust C, Dimick JB, Birkmeyer NJ, Skinner JS. Hospital quality and the cost of inpatient surgery in the United States. Ann Surg 2012;255(1):1-5. doi: 10.1097/sla.0b013e3182402c17
Overend TJ, Anderson CM, Lucy SD, Bhatia C, Jonsson BI, Timmermans C. The effect of incentive spirometry on postoperative pulmonary complications: a systematic review. Chest 2001;120(3):971-8. doi: 10.1378/chest.120.3.971
Restrepo RD, Wettstein R, Wittnebel L, Tracy M. Incentive spirometry: 2011. Respir Care 2011;56(10):1600-4. doi: 10.4187/respcare.01471
Carvalho CR, Paisani DM, Lunardi AC. Incentive spirometry in major surgeries: a systematic review. Rev Bras Fisioter 2011;15(5):343-50. doi: 10.1590/s1413-35552011005000025
Santos EC, Silva JS, Assis Filho MTT, Vidal MB, Lunardi AC. Use of lung expansion techniques on drained and non-drained pleural effusion: survey with 232 physiotherapists. Fisioter Mov 2020;33:1-10. doi: 10.1590/1980-5918.33.ao05
Eltorai AEM, Baird GL, Eltorai AS, Healey TT, Agarwal S, Ventetuolo CE et al. Effect of an incentive spirometer patient reminder after coronary artery bypass grafting: a randomized clinical trial. JAMA Surg 2019;154(7):579-88. doi: 10.1001/jamasurg.2019.0520
Iverson LI, Ecker RR, Fox HE, May IA. A comparative study of IPPB, the incentive spirometer, and blow bottles: the prevention of atelectasis following cardiac surgery. Ann Thorac Surg 1978;25(3):197-200. doi: 10.1016/s0003-4975(10)63521-7
Yazdannik A, Bollbanabad HM, Mirmohammadsadeghi M, Khalifezade A. The effect of incentive spirometry on arterial blood gases after coronary artery bypass surgery (CABG). Iran J Nurs Midwifery Res 2016;21(1):89-92. doi: 10.4103/1735-9066.174761
Narayanan ALT, Hamid SRGS, Supriyanto E. Evidence regarding patient compliance with incentive spirometry interventions after cardiac, thoracic and abdominal surgeries: A systematic literature review. Can J Respir Ther 2016;52(1):17-26.
Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009;6(7):e1000097. doi: 10.1371/journal.pmed.1000097
Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page M et al. (eds). Cochrane Handbook for Systematic Reviews of Interventions. 2nd ed. Chichester UK: The Cochrane Collaboration and John Wiley & Sons; 2019. 703 p. doi: 10.1002/9781119536604
Eltorai AEM, Szabo AL, Antoci V Jr, Ventetuolo CE, Elias JA, Daniels AH et al. Clinical effectiveness of incentive spirometry for the prevention of postoperative pulmonary complications. Respir Care 2018;63(3):347-52. doi: 10.4187/respcare.05679
Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan – a web and mobile app for systematic review. Syst Rev 2016;5:210. doi: 10.1186/s13643-016-0384-4
Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther 2003;83(8):713-21. doi: 10.1093/ptj/83.8.713
Yamato TP, Maher C, Koes B, Moseley A. The PEDro scale had acceptably high convergent validity, construct validity, and interrater reliability in evaluating methodological quality of pharmaceutical trials. J Clin Epidemiol 2017;86:176-181. doi: 10.1016/j.jclinepi.2017.03.002
GRADE Working Group. Grading quality of evidence and strength of recommendations. BMJ 2004;328(7454):1490. doi: 10.1136/bmj.a139
GRADEpro GDT 2015. Grade"™s software for summary of findings tables, health technology assessment and guidelines. https://gradepro.org
Review Manager 5 (RevMan 5) [Computer program]. Version 5.3. Copenhagen: Nordic Cochrane Centre, Cochrane; 2014.
Rupp M, Miley H, Russell-Babin K. Incentive spirometry in postoperative abdominal/thoracic surgery patients. AACN Adv Crit Care 2013;24(3):255-63. doi: 10.4037/nci.0b013e31828c8878
Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA. Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 statement. Syst Rev 2015;4(1):1. doi: 10.1186/2046-4053-4-1
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Copyright (c) 2020 Elinaldo da Conceição dos Santos, Ana Carolina Pereira Nunes Pinto, Juliana Ribeiro Fonseca Franco de Macedo, Adriana Claudia Lunardi
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