Comparison of two methods of postoperative respiratory care

After abdominal surgery, 64 patients were managed with one of the following two techniques of respiratory care: (1) deep breathing by way of a new device, an incentive spirometric three-ball, flow-measuring device (Triflo); and (2) standard episodic intermittent positive-pressure breathing (IPPB) every four hours. Both series of patients received therapy with a bronchodilator drug by nebulization. All patients had preoperative spirometric measurements followed by five consecutive days of therapy and spirometry. Chest x-ray films were obtained for all patients. There were no significant differences between the two methods of respiratory care, but 57 percent (17/30) in the group receiving therapy with IPPB developed pneumonia, atelectasis, or bronchitis, while only 29 percent (10/34) did so in the group using the incentive spirometric device (P less than 0.05). Spirometric differences were minimal, although the trend favored the incentive spirometric device. Principal conclusions were as follows: (1) deep breathing under the conditions of this investigation was equal to episodic therapy with IPPB; and (2) from an economic standpoint, IPPB, as it is currently practiced, may be disadvantageous when compared with the incentive spirometric device.