INCENTIVE SPIROMETRY (SUSTAINED MAXIMAL INSPIRATION)
Incentive spirometry is a method of deep breathing that pro-vides visual feedback to help the patient inhale slowly and deeply to maximize lung inflation and prevent or reduce atelectasis. Ide-ally, the patient assumes a sitting or semi-Fowler’s position to en-hance diaphragmatic excursion (Chart 25-4). However, this procedure may be performed with the patient in any position.
Incentive spirometers may be one of two types: volume or flow. In the volume type, the tidal volume of the spirometer is set according to the manufacturer’s instructions. The purpose of the device is to ensure that the volume of air inhaled is increased gradually as the patient takes deeper and deeper breaths. The pa-tient takes a deep breath through the mouthpiece, pauses at peak lung inflation, and then relaxes and exhales. Taking several nor-mal breaths before attempting another with the incentive spirom-eter helps avoid fatigue. The volume is periodically increased as tolerated.
A flow spirometer has the same purpose as a volume spirom-eter, but the volume is not preset. The spirometer contains a number of movable balls that are pushed up by the force of the breath and held suspended in the air while the patient inhales. The amount of air inhaled and the flow of the air are estimated by how long and how high the balls are suspended.
Incentive spirometry is used after surgery, especially thoracic and abdominal surgery, to promote the expansion of the alveoli and to prevent or treat atelectasis. As a preventive measure, incentive spirometry may be more effective than IPPB because it maximizes the amount of air inhaled while maintaining relatively low airway pressures.
Nursing management of the patient using incentive spirometry includes placing the patient in the proper position, teaching the technique for using the incentive spirometer, setting realistic goals for the patient, and recording the results of the therapy.