Does Incentive Spirometer decrease a temp?

Ive been taught that it does, but a doc told a patient that was hogwash. Ive been told by other docs to have patients do it for a temp. Ive seen it work (I think), not sure if it was the IS that did it. I know it is used to decrease risk for pneumonia, but temp? Does anyone know for sure? Thanks.

Maybe as a secondary benefit?

Because hypoventilation and atelectasis are some of the most common issues plaguing the acutely ill hospital patient and predispose him/her to pneumonia, Sustained Maximal Inflation or SMI therapy is first line treatment. Incentive spirometry is a widely used patient driven modality and has been for many years. There are others too but they all basically promote lung expansion and mobilize secretions. During my career as a respiratory therapist I found that more than half of the time, the device is confusing for the patient and I was moved to just coach the deep breathing and coughing. After all, it's not mastery of the tool that gives the benefit, it's the breathing and causing the patient undue frustration is counterproductive.

R

Ricu wrote:Because hypoventilation and atelectasis are some of the most common issues plaguing the acutely ill hospital patient and predispose him/her to pneumonia, Sustained Maximal Inflation or SMI therapy is first line treatment. Incentive spirometry is a widely used patient driven modality and has been for many years. There are others too but they all basically promote lung expansion and mobilize secretions. During my career as a respiratory therapist I found that more than half of the time, the device is confusing for the patient and I was moved to just coach the deep breathing and coughing. After all, it's not mastery of the tool that gives the benefit, it's the breathing and causing the patient undue frustration is counterproductive.

R

Yes, however the IS provides a gauge [marker] for which the patient & nurse can use to indicate progress. Progress for the patient can further provide motivation & continued recovery... thus the IS is a very productive tool. Yet, I do agree the practice of turn/cough/deep breathing is very productive, as well.

Back to the main topic; Has anyone read evidenced based literature on the IS lowering the patient's temperature?

Who has time to READ, pray tell???? My line of thinking is based on clinical experience only, and yes, I have seen that it works and doesn't work; I'd say 50-50. One pt had a temp of 103, I called the Doc and he told me to get him up and walk him around the unit x3, and, lo and behold, his temp was back to normal. Gotta agree that anything expanding the lungs must work, and I promote C&DB AT LEAST once every shift!

IS does work in the long run but not immediately. When I was hospitalized in Nov they would take my temp and it would be up then ask me to do the IS and take temp again immediately it doesn't work that fast.

IS is and does all of those things so long as the primary cause of the temp is stasis issues. IS won't treat other causes of fever, like a septic gallbladder which is why we look at the complete picture.

R

I've always thought it worked, but I've never read any lit on it myself. I still think it's a good idea to do it even if it doesn't reduce all fevers.

I would like to know about reasearch studies on this topic.
IS is defiately benifical, but I wonder if it any more benificial than walk walk walk cough cogh cough!!!!

cassioo wrote:IS does work in the long run but not immediately. When I was hospitalized in Nov they would take my temp and it would be up then ask me to do the IS and take temp again immediately it doesn't work that fast.

ACTUALLY IS DOES!!! Your lungs are like a radiator in a car, if you will, and the increased inspiratory effort, done repeatedly absolutely will help decrease temp. Now that may be temporary, but I've seen drop as much as 2.5 degrees in 30minutes, with good effort. Get your car stuck in traffic on a hot day, kind of like being on bedrest, the radiator doesn't get good airflow, likewise, laying in bed, with minimal exertion, and minimal resp. effort, equals poor air flow through the lungs. Incentive Spirometry is one of the best ways to get your patient to "blow" off his/her temp, but it DOES REQUIRE GOOD EFFORT!!!

I haven't read anything but.... If the reason a patient is temping is that he has a big phlegm blockage it sure can work. It has helped in my 17 years for sure. Who cares about literature anyway. Medicine works best hands on...forget the papers! :houra:

I would think it would be a case of where it would be very difficult to scientifically prove because there could be any number of reasons for the temp to go down, and using an incentive spirometer would definitely not be first on the list of treatments for an elevated temperature. So unless that was the first and only thing you did for the temp, there's little way to confirm.

I am a huge fan of an incentive spirometer though, as a proactive measure.

IS has been on of our QI (PI, QA whatever it is today being called) studies for a year or so now because we know we do it but nobody was charting it...it it's still not getting charted for the most part.

nurse1stik wrote:I haven't read anything but.... If the reason a patient is temping is that he has a big phlegm blockage it sure can work. It has helped in my 17 years for sure. Who cares about literature anyway. Medicine works best hands on...forget the papers! :houra:

Evidenced based practice documented in the literature is what brings validity to nursing practices & procedures. ;)

OhbowhntrRN wrote:ACTUALLY IS DOES!!! Your lungs are like a radiator in a car, if you will, and the increased inspiratory effort, done repeatedly absolutely will help decrease temp. Now that may be temporary, but I've seen drop as much as 2.5 degrees in 30minutes, with good effort. Get your car stuck in traffic on a hot day, kind of like being on bedrest, the radiator doesn't get good airflow, likewise, laying in bed, with minimal exertion, and minimal resp. effort, equals poor air flow through the lungs. Incentive Spirometry is one of the best ways to get your patient to "blow" off his/her temp, but it DOES REQUIRE GOOD EFFORT!!!

With all due respect to your education and credentials, your "observation" does not qualify for a definitive answer to the question. SMI's (sustained maximal inspiration devices) or incentive spirometery has no effect on a patient's temp and neither does nebulizer treatments with albuterol (which also gets ordered for post op temps sometimes. If it did, it would be prescribed for temps of all kinds. But the truth is, SMIs are going the way of IPPB as they did not have any real effect either...so if a machine (IPPB) that MADE you take a deep breath was deemed ineffective, how much more so is SMI? The bottom line is evidence based studies and here's a couple of links that reviewed many studies of SMIs and the conclusion was there was no real benefit from them:
The Effect of Incentive Spirometry on Postoperative Pulmonary Complications* ? CHEST
Incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery

The physicians that order them for temp are just misinformed as to their intended purpose, which we are learning now was wrong. We have revised our policies here at our hospital based on these and other studies for doing SMI

RRT, RPFT, AE-C

mturner27 wrote:With all due respect to your education and credentials, your "observation" does not qualify for a definitive answer to the question. SMI's (sustained maximal inspiration devices) or incentive spirometery has no effect on a patient's temp and neither does nebulizer treatments with albuterol (which also gets ordered for post op temps sometimes. If it did, it would be prescribed for temps of all kinds. But the truth is, SMIs are going the way of IPPB as they did not have any real effect either...so if a machine (IPPB) that MADE you take a deep breath was deemed ineffective, how much more so is SMI? The bottom line is evidence based studies and here's a couple of links that reviewed many studies of SMIs and the conclusion was there was no real benefit from them:
The Effect of Incentive Spirometry on Postoperative Pulmonary Complications* ? CHEST
Incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery

The physicians that order them for temp are just misinformed as to their intended purpose, which we are learning now was wrong. We have revised our policies here at our hospital based on these and other studies for doing SMI

RRT, RPFT, AE-C

What evidence based study does is shine a light on the efficacy of current practice AS APPLIED.

For the purpose of this discussion, let's think that anybody who orders IS(or other device) isn't under the assumption that there is therapeutic effect in just putting the thing in a patient's mouth. (We'll save the wonders of Albuterol discussion for another place.) Maybe we can agree that the most important but usually neglected part of incentive spirometry along with enthusiastic encouragement and support, is the proper instruction in splinting, coughing, deep breathing and airway clearance. It's the THERAPY that treats postoperative fever due to atelectasis from pain and/or drug related hypoventilation not the ball in the tube.

Theoretically, this "treatment" should be effective but the research offered here hasn't supported that. Standardizing technique or instruction methodology is challenging but nevertheless, it was not even addressed in the abstracts posted and those things are crucial for successful therapy. Rather than condemn SMI, let's consider the quality or consistency of technical support and we'll have a better understanding of the problem. Additionally, no single therapy is effective alone but works best in conjunction with everything else that falls under the heading of early postoperative mobilization.

My belief is in a team approach. In a collaborative effort along with nursing, as with PT/OT/ST, what should be ordered is: Resipratory Therapy to evaluate and treat. The respiratory therapist would review the case, assess the patient and within a scope of practice, initiate appropriate treatment. Drug therapies if indicated, would be used after a call to the physician. I wonder what outcomes would look like when what is reflected is ownership of and vestiture in the quality of care and not specific devices or inappropriate orders. Let's raise the bar.


mturner27, you said policies have been changed in your institution. How so?

R

RN, CCRN, RRT

Hey Ricu, outstanding post. Nice read. Healthcare is always best as a Team.

SoldierNurse wrote:Hey Ricu, outstanding post. Nice read. Healthcare is always best as a Team.

Thanks.

Ricu wrote:What evidence based study does is shine a light on the efficacy of current practice AS APPLIED.

For the purpose of this discussion, let's think that anybody who orders IS(or other device) isn't under the assumption that there is therapeutic effect in just putting the thing in a patient's mouth. (We'll save the wonders of Albuterol discussion for another place.) Maybe we can agree that the most important but usually neglected part of incentive spirometry along with enthusiastic encouragement and support, is the proper instruction in splinting, coughing, deep breathing and airway clearance. It's the THERAPY that treats postoperative fever due to atelectasis from pain and/or drug related hypoventilation not the ball in the tube.

Theoretically, this "treatment" should be effective but the research offered here hasn't supported that. Standardizing technique or instruction methodology is challenging but nevertheless, it was not even addressed in the abstracts posted and those things are crucial for successful therapy. Rather than condemn SMI, let's consider the quality or consistency of technical support and we'll have a better understanding of the problem. Additionally, no single therapy is effective alone but works best in conjunction with everything else that falls under the heading of early postoperative mobilization.

My belief is in a team approach. In a collaborative effort along with nursing, as with PT/OT/ST, what should be ordered is: Resipratory Therapy to evaluate and treat. The respiratory therapist would review the case, assess the patient and within a scope of practice, initiate appropriate treatment. Drug therapies if indicated, would be used after a call to the physician. I wonder what outcomes would look like when what is reflected is ownership of and vestiture in the quality of care and not specific devices or inappropriate orders. Let's raise the bar.


mturner27, you said policies have been changed in your institution. How so?

R

RN, CCRN, RRT

As far as outcomes go, we monitor our post op pulmonary complications at our facility and they actually went DOWN after discontinuing the automatic standing orders, which by the way was the change we made in our facility. Before the change, EVERY SINGLE POST OP had a standing order on a pre printed order sheet for IS q1 h w/a. Of course the most anyone received was IS QID, as per policy at the time. [To my knowledge, no one really believes this effects a temp but a very few] This included every toe, knuckle, knee, etc operated on. This also caused our dept to staff an additional 2.5 FTE for the only purpose of doing IS. I don't know about your facility, but we had to take a look at how we are doing things here and tighten our belt. (mandatory salary budget cuts) So we had to be better and effective at what we were doing. By your own statement, it is the "technique" not the ball of the IS that has any "effect" and that is what the study showed. IS is no better than deep breathing and coughing...SO why do them? In my experience it came down to two types of patients: One- the compliant pt that will do anything they are told to facilitate recovery, in which case proper instruction on the front end will suffice and IS is not needed and TWO the non-compliant patient, in which they will not do as instructed and all the IS and DB & C coaching in the world will not change that and of course IS will not help them either.
The policy change, which was approved by our medical director, simply stated that our dept will no longer do "standing order IS" that we WILL be available to treat any patient that the Dr or nurse has a concern about and that we will tx as indicated per our protocols. The exception (for now) are the CABG patients while they are still in the unit (but dc'd when they go to the floor, and Gastric bypass pts receive an initial instruct and are put on their own after surgery.
I agree with you that patients should receive an order for RT to assess and treat anyone there is a concern about. We have the ability here to order and treat patients with most of the medications we provide per our protocols. But I do not believe that includes an RT to go in and instruct every post op patient they should cough and DB q 1 h w/a. Change is difficult, but required if we are to succeed in our profession. Gone are the days when every patient that gets admitted receives all the standard EKG, chest-xrays, rainbow labs, etc...we have to be smarter with staffing and treatment which includes reducing length of stay as much as possible with as little cost as possible. If we don't, we will wind up like several other hospitals in our state and close the doors all together.

mturner27 wrote:As far as outcomes go, we monitor our post op pulmonary complications at our facility and they actually went DOWN after discontinuing the automatic standing orders, which by the way was the change we made in our facility. Before the change, EVERY SINGLE POST OP had a standing order on a pre printed order sheet for IS q1 h w/a. Of course the most anyone received was IS QID, as per policy at the time. [To my knowledge, no one really believes this effects a temp but a very few] This included every toe, knuckle, knee, etc operated on. This also caused our dept to staff an additional 2.5 FTE for the only purpose of doing IS. I don't know about your facility, but we had to take a look at how we are doing things here and tighten our belt. (mandatory salary budget cuts) So we had to be better and effective at what we were doing. By your own statement, it is the "technique" not the ball of the IS that has any "effect" and that is what the study showed. IS is no better than deep breathing and coughing...SO why do them? In my experience it came down to two types of patients: One- the compliant pt that will do anything they are told to facilitate recovery, in which case proper instruction on the front end will suffice and IS is not needed and TWO the non-compliant patient, in which they will not do as instructed and all the IS and DB & C coaching in the world will not change that and of course IS will not help them either.
The policy change, which was approved by our medical director, simply stated that our dept will no longer do "standing order IS" that we WILL be available to treat any patient that the Dr or nurse has a concern about and that we will tx as indicated per our protocols. The exception (for now) are the CABG patients while they are still in the unit (but dc'd when they go to the floor, and Gastric bypass pts receive an initial instruct and are put on their own after surgery.
I agree with you that patients should receive an order for RT to assess and treat anyone there is a concern about. We have the ability here to order and treat patients with most of the medications we provide per our protocols. But I do not believe that includes an RT to go in and instruct every post op patient they should cough and DB q 1 h w/a. Change is difficult, but required if we are to succeed in our profession. Gone are the days when every patient that gets admitted receives all the standard EKG, chest-xrays, rainbow labs, etc...we have to be smarter with staffing and treatment which includes reducing length of stay as much as possible with as little cost as possible. If we don't, we will wind up like several other hospitals in our state and close the doors all together.

You're doing less incentive spirometry, necessary or otherwise and that's good in a way. I don't like mindless standing orders either. Say more about what your department IS doing. How often is the respiratory therapist being called to assess? If your patient load is anything like ours, there are a whole lot of really sick people out there which should make you very busy.