Incentive spirometry

Incentive spirometry, which is also known as sustained maximal inspiration, is the most widely used method of bronchial hygiene therapy, but it requires the co-operation of the patient. It attempts to mimic the natural sighing or yawning that a healthy subject performs nine or ten times every hour. The patient is encouraged to take long slow deep breaths.

Maximum inspiration is facilitated by using an indicator (usually visual) that informs the patient that he or she has produced sufficient flow or insufflatory volume and maintained it for a sufficiently long period (at least 3 s). Of course, ample ventilation without technical aid is possible and can be as beneficial as incentive spirometry.

The contraindication is essentially a lack of co-operation. Incentive spirometry is not suitable for patients with a vital capacity less than 10 ml/kg.

Incentive spirometry should be superior to percussion and directed cough as a method of increasing mucus clearance and treating sputum retention, but, despite many studies, the superiority of this technique has not been clearly demonstrated ( Beljet..etal 1995). However, it should be as effective as intermittent positive-pressure ventilation with less frequent undesirable effects. Incentive spirometry must not be confused with expiratory maneuvers (blow bottles) which can be harmful because they result in a decrease in pulmonary volumes.

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