Incentive Spirometry

Incentive Spirometry

I. S. Introduction
* Also called SMI (sustained maximal inspiration)
* Involves the use of a device that encourages a patient to make larger-than-normal inspiratory effort and establish a breathing incentive
* Involves pt. mentally and physically and is less expensive and usually as effective as IPPB
* I. S. devices let the patient see their own progress
* Results in the generation of increased negative transpulmonary pressures increased Vt for the primary purpose of opening and stabilizing atelectatic areas of the lung against recurrent atelectasis
* Prevention of postoperative complications
- primary purpose is to help open closed alveoli, facilitate the cough reflex, help mobilize secretions, and prevent hyperventilation.

* Preoperative “cleanup”, which strengthens pulmonary muscles, increases voluntary ventilation, improves “bronchial toilet”
* Psychological support


Contraindications for I. S.
* Uncooperative or physically disabled pt.
* Patient with mental or CNS disorders
* Patients that are physically unable to generate large enough Vt (10-15 ml/kg)

Hazards and Complications of I.S.
* Hyperventilation may occur if SMI is performed too rapidly, without rest periods between deep breaths, which may lead to dizziness, light-headedness, a tingling sensation in the extremities, and possible muscle tremors
* Barotrauma in pt. with emphysematous blebs
* Pulmonary embolism from decrease Ppl

Procedure for I. S.

* Determine baseline volume expectations
* If post-op, set realistic, achievable goals initially and increase level by 200 ml until pt. reaches desired Vt
* Make sure pt. understands proper use of device
* Stress importance of achieving goals and coughing to clear secretions
* Splint surgical incisions
* Noseclips can be used to better facilitate a deep breath
* Asses pt., incl. V.S. and chest auscultation
* Explain and demonstrate
* Proper technique includes having pt. inspire slowly and deeply from FRC
* At the end of max. inspir. have pt. do breath hold for 5 sec.
* Repeat 6 - 10 times or as prescribed
* Instruct proper cough
* Reassess pt.

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The Respiratory System and Spirometry

The Respiratory System & Spirometry

* Identify parts of the respiratory system
* Examine histology of the: Trachea, Lung
* Examine the operation of the lung model
* Biopac L012-Lung-1: Spirometry
o Measure lung volumes and capacities

Respiratory System Structure
* Conduction zone: pathway for pulmonary ventilation
* Respiratory zone: membrane for gas exchange external respiration
* Clinically, two parts:
o Upper respiratory tract
o Lower respiratory tract
Histology reflects the different functions of the different parts of the system
Position in respiratory pathway determines cell type
* non-keratinized stratified squamous
* pseudostratified ciliated columnar
* cuboidal ciliated
* simple squamous / Type I Alveolar cells

Pseudostratified Columnar Epithelium
Lamina Propria
Hyaline Cartilage
mucosa
Submucosa
seudostratified epithelium = lamina propria
ucous glands
mooth muscle
artilage
Gross Section Through Lung
Smoker’s Lungs
Non-smoker
Small Bronchiole
Lung Tissue slide
Respiratory Bronchiole
Alveolar Duct
Alveoli
Alveolar Sac
Capillaries in Alveolar Wall
Spirometry
SPIROMETRY – RESPIRATORY VOLUMES AND CAPACITIES

Total Lung Capacity = Inspiratory Reserve Volume (IRV) + Tidal Volume (TV) + Expiratory Reserve Volume (ERV) + Residual Volume (RV)
Vital Capacity = Inspiratory Reserve Volume (IRV) + Tidal Volume (TV) + Expiratory Reserve Volume (ERV)
Inspiratory Capacity = Inspiratory Reserve Volume (IRV) + Tidal Volume (TV)
Functional Residual Capacity = Expiratory Reserve Volume (ERV) + Residual Volume (RV)

Spirometry – Calibration
Insert the calibration syringe/filter assembly into the side of the airflow transducer labeled "Inlet."
Inlet
Wait for 8 seconds of no air flow Inlet
Experimental Treatments

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Spirometry

Spirometry

Respiration
* External respiration – Gas exchange between blood and alveoli
* Internal respiration – Gas exchange between blood and tissue cells

Pulmonary Ventilation
* Inspiration – Diaphragm and intercostals muscles contract resulting in increased volume and decreased pressure in the thoracic cavity; air rushes in
* Expiration – Diaphragm and intercostals muscles relax resulting in decreased volume and increased pressure in the thoracic cavity; air pushed out

Respiratory Volumes
* Tidal volume - normal amount of air inhales or exhaled
* Inspiratory reserve volume amount of air that can be forcefully inhaled after normal inhalation
* Expiratory reserve volume – amount of air that can be forcefully exhaled after normal exhalation
* Vital capacity – maximum amount of air that can be exhaled after maximum inhalation
* Residual volume – amount of air that can be exhaled after maximum inhalation

Factors altering normal function
* Diseases
* Disorders
* Pollutants in the environment
* Trauma

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