Original Title: Utilisation de la spirométrie incitative pour la prévention des complications pulmonaires à la suite d’une chirurgie

Authors' objectives: In the postoperative period, pulmonary complications are frequent and are an important cause of morbidity and mortality. Strategies for preventing postoperative pulmonary complications (PPCs) are founded on active breathing exercises involving maximum and sustained inspiration with the goal of lung expansion. Incentive spirometry (IS) is one of the strategies which, using a device, aims to facilitate such breathing exercises. Although IS is widely practised in hospitals, its effectiveness and routine use postoperatively is controversial. The Nursing Directorates of the CHU de Québec-Université Laval (CHU de Québec) and the Quebec Heart and Lung Institute – Laval University (Institute) requested the Health Technology Assessment Unit (HTAU) assess the safety and efficacy of IS for the prevention of PPCs.

Authors' results and conclusions: The following elements emerged from clinical practice guidelines: 1) IS and other airway clearance techniques could have similar clinical benefits for the prevention of PPCs, regardless of the type of surgery; 2) the routine use of IS would not be recommended for the prevention of PPCs; 3) IS should be used in combination with other PPC prevention techniques, such as early mobilization and deep breathing exercises. The available evidence does not support establishing the superiority or inferiority of IS over other methods evaluated for preventing pulmonary complications following upper abdominal, cardiac, or thoracic surgery. Although a large number of studies (n=20) were available on the subject, their many methodological shortcomings limit the possibility of making an informed judgment on the benefit of IS. At the CHU de Québec, IS is mainly used for patients with risk factors or with pulmonary complications. At the Institute, IS is used to prevent PPCs for all hospitalized patients.

Authors' recommendations: In considering the data from clinical practice guidelines as well as the experiential data from the practice survey, it appears that the use of IS in the postoperative period must be considered more broadly as part of a strategy of care aimed at preventing the risk of pulmonary complications involving several co-interventions, with a view to clinical relevance and better use of resources. The HTAU recommends that the Nursing Directorates of the CHU de Québec and the Institute revise the use of IS for the prevention of PPCs in order to better target the patients who would benefit and to better define the place of other available strategies. It is also suggested to put in place mechanisms to ensure the applicability and respect of the care method, including the teaching and supervision of IS.

Project Status: Completed

URL for project: https://www.iucpq.ca/a-propos-de-nous/excellence/evaluation-des-technologies-et-modes-dintervention-en-sante/

Year Published: 2019

URL for published report: https://iucpq.qc.ca/sites/default/files/rapport_04_19-_spirometrie.pdf

Requestor: Nursing Directorates

English language abstract: There is no English language summary available

Publication Type: Full HTA

Country: Canada

Province: Quebec

Organisation Name: Institut universitaire de cardiologie et de pneumologie de Québec – Université Laval (IUCPQ-ULaval)

Contact Address: 2725, chemin Sainte-Foy Québec QC G1V 4G5

Contact Name: uetmis.iucpq@ssss.gouv.qc.ca

Contact Email: uetmis.iucpq@ssss.gouv.qc.ca

Copyright: Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval