A REVIEW OF EVIDENCE BASED PRACTICE
ERIN BURDI, ASHLEY JACOBSON, MELANIE LYON,
RACHEL NIVISON, & PAULA SAWYER
FERRIS STATE UNIVERSITY
It is our responsibility as
nurses to advocate for our
patients.
This includes, but is not
limited to, developing a
individualized patient plan of
care with evidence based
interventions to help them
attain their highest level of
function.
Nurses also have a
responsibility to periodically
review current interventions and
practice to ensure that they are
the most up to date and evidence
based for patients in their
care.
Provide a review of evidence based research
applied to the use and effectiveness of
Incentive Spirometry (IS) for patients
having under gone Coronary Artery Bypass
Grafting (CABG) surgery.
Respiratory
complications are
common in patients
who have had a
CABG
“Up to 65% of
patients may have
atelectasis, and
3% may develop
pneumonia”
(Pasquina et al,2003,p.1).
Research has found
the addition of IS
to a regimen of
early mobilization
and C&DB did not
improve
postoperative lung
function more
rapidly”
(Jenkins,et.al,1989,pp 637-638).
The evidence based research reviewed regarding
the advantage of IS with CABG patients seems
ambiguous.
Strider et al. (1994)
researched the IS and its
effectiveness on pulmonary
shunts.
Jenkins et al. (1989)
studied the effects of IS
included with huffing and
deep breathing
Advantage:
• Attempted to control
internal validity by
monitoring
physiotherapists.
Limitation:
• Population included only
men.
Limitations:
• Sample size was small.
•
Population included only
intubated patients.
Harton et al.(2007)
researched the
percentage of
preoperative IS volume
achieved using IS after
cardiac surgery.
Advantage:
•
Standardized teaching
helped improve internal
validity.
Gale & Sanders (1980)
compared the use of IS
with intermittent
positive pressure
breathing.
Limitations:
•
Inconsistencies in the
method of treatment:
respiratory therapists were
not monitored.
•
Treatments only performed
4x per day: previous
research states IS should
be used 10x per hour.
Limitation:
•
Inconclusive of how long it
would take patients to
achieve 100% preoperative
volume.
Even in the shadow of research
ambiguity, IS remains an
integral part of post
operative nursing care and a
frequently used technique for
prophylaxis of respiratory
complications nationwide.
95% of hospitals in the United
States that perform
cardiothoracic or abdominal
surgeries still utilize IS as
a part of post operative care
(Overend et al.,2001, p.972).
This includes the West
Michigan Cardiothoracic
Surgeons (WMCTS) at Spectrum
Health in Grand Rapids,
Michigan.
The WMCTS on the
Cardiovascular Unit at
Spectrum Health order IS in
conjunction with C&DB and
early ambulation as a
standard plan of care for
their post CABG patients.
Nurses on this unit are
trained to assist patients
with these techniques as
early as twelve hours post
procedure.
Patients are instructed to
use the IS and C&DB hourly
while in bed and are
mobilized up to their chair
for meals and assisted to
ambulate in the unit
hallways four times a day.
Patient compliance with treatment is a determining
factor to the success of treatment and pain
control plays a major role in patient compliance.
CABG patients experience incisional pain, acute
pain related to invasive lines and chest tubes,
and musculoskeletal pain from intra-operative
positioning.
While pain is a subjective experience and relative
to the individual, most post CABG patients arrive
to the unit with a lot of pain
Cardiovascular nurses on
this unit are trained to
expect and manage these
types of pain with
prescribed analgesics,
splinting techniques, and
patient positioning in
order to facilitate
WMCTS’ prescribed
activities.
While the evidence that we as group
have reviewed indicates no specific
benefit to IS and C&DB exercises, as a
cardiovascular nurse of ten years on
this unit, I have personally witnessed
the difference in the recovery of post
CABG patients compliant with the
prescribed course of treatment.
Patients compliant with this course of
treatment seem to recover quicker and
have fewer complications.
Therefore in compliance with WMCTS’
recommendations, cardiovascular nurses
on this unit continue to incorporate
these methods in their patient’s plan
of care.
The evidence is inconclusive
Cardiothoracic Surgeons still
IS as standard practice
Nurses can take two different
Choose to continue to teach
Choose not to teach the use
incorporate
paths
the use of IS
of IS
Based on Nursing judgment &
experience, we believe that the
use of IS practice still offers
benefits to patients.
Patient education plays a vital
role to IS’ effectiveness.
Nurses should:
Ensure all patients receive
same teaching
Teach correct use
Encourage frequent use
Nurses should always remain
dedicated to our role as patient
advocates.
Harton, S., Grap, M., Savage, L., & Elswick, R. (2007). Frequency and
predictors of return to incentive spirometry volume baseline after
cardiac surgery. Progress in Cardiovascular Nursing , 22(1), 7-12.
Retrieved from CINAHL database.
Jenkins, S. C., Soutar, S. A., Loukota, J. M., Johnson, L. C., &
Moxham, J. (1989). Physiotherapy after coronary artery surgery: are
breathing exercises necessary? Thorax, 44(8), 634-639. Retrieved from
PubMed (2799743).
Nieswiadomy, R. M. (2008). Foundations of Nursing Research (fifth ed.
, pp. 201-202). Upper Saddle River, NJ: Pearson Prentice Hall.
Overend, T., Anderson, C., Lucy, S., Bhatia, C., Jonsson, B., &
Timmermans, C. (2001). The effect of incentive spirometry on
postoperative pulmonary complications: a systematic review. CHEST,
120(3), 971-978. Retrieved from CINAHL database.
Pasquina, P., Tramèr, M., & Walder, B. (2003). Prophylactic
respiratory physiotherapy after cardiac surgery: systematic review.
BMJ: British Medical Journal , 327(7428), 1379-1381. Retrieved from
CINAHL database.
Strider, D. , Egloff, M., Burns, S. M., & Truwit, J. D. (1994).
Stacked inspiratory sprirometry reduces pulmonary shunt in patients
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