الفهرس 
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Abstract
Postoperative pulmonary complications (PPCs) after the cardiac surgery are the main cause of morbidity and mortality. It’s associated with increased length of stay in hospital and these have a great influence on health care cost in cardiac surgery patients. The high incidence of pulmonary complications is in part due to the disruption of normal ventilatory function that is inherent to surgery in the thoracic region. Physiotherapy techniques of lung re-expansion have been suggested as strategies to prevent and treat the PPCs.
The incentive spirometer has been widely used for lung expansion and the prophylaxis of pulmonary complications, especially in post-cardiac surgeries, due to easy to use,cost-effective, and the good adherence of patients to the method. Incentive spirometer has attained widespread usage in the postoperative phase for the treatment and prevention of respiratory complications. However, despite the universal use of incentive spirometry in the postoperative period, the studies on its efficiency are contradicted, and high-quality evidence is missing.
The aim of this study was:
Assess the effect of using incentive spirometry program on post cardiac surgery patients’ respiratory outcomes.
Research design:
A Quasi-experimental research design was used to conduct this study.
Setting:
This was carried out in the open heart critical care units (2 units) at Alexandria university main hospital.
Subjects:
A convenience sample of 50 post-cardiac surgery adult patients of box sex who are newly admitted in the previously mentioned setting with GCS>13, able to communicate andtheir age ranged from 18 to 65 years were included in this study. Patients who were delirious, heavily sedated or comatose,hemodynamic instability (dangerous dysrhythmia, cardiogenic shock, severe hypotension) and required reintubation or reoperation were excluded from this study.
Tool of the study:
One tool was used to collect data of this study. This tool named: ’’Incentive spirometry outcomes assessment tool’’.This tool was used to assess the effect of incentive spirometry program on patients’ respiratory outcomes. The tool consists of four parts: part I ‘‘Patients’ Socio-Demographic and Clinical Data’’, part II ’’Patients physiological parameters’’, part III ’’Respiratory variance factors’’ and part IV ’’Incentive spirometry checklist’’.
Data collection:
A written approval of ethics committee of the faculty of nursing was obtained. Permission to conduct the study was obtained from hospital responsible authority after explanation of aim of the study and delivery of an official letter from the Faculty of Nursing. The study tool was tested for content validity by 7 experts in the field of the study. The necessary modifications were done accordingly. Reliability of the study tool was tested using Coefficient Alpha test and results were 0.77. A pilot study was carried out on 10% of the study sample in order to test the clarity and applicability of the study tool.
Statistical analysis of the data:
After completion of data collection, statistical tests were carried out using IBM SPSS software package version 20.0. for both data presentation and statistical analysis of the result. The number and percentage were used for describing and summarizing qualitative data. Mean and standard deviation were used to present the quantitative data. The significance of the obtained results was judged at the 5% level.
The results of the study:
The main results of the current study revealed thatthere was no statistically significant difference between the intervention and control groups regarding age, sex, education, and marital status (p=0.284, 0.733, 0.846, and 0.487 respectively), it was noted that the mean age of the intervention group was 54.12 ± 9.15years as compared to 51.32 ± 9.10 years of the control group, male patients represented 76% of the intervention group as compared to 80% of the control group, most of the intervention and control groups have primary and secondary education and it was 92% of patients in the intervention group were married in comparison to 96% in the control group.
The most common type of operation was CABG; it was 56% in the intervention group and 48% in the control group. The mean of APACHE-II score in the intervention group was 10.20 ± 1.80 and in the control group was 10.08 ± 0.95. In relation to medications, it was noted that all patients of both studied groups received bronchodilators followed by diuretics (80.0% of the intervention group 72.0% of the control group).
In the intervention group, there was no significant correlation between patients’ respiratory improvement and use of incentive spirometry during the first postoperative day (r =0.010, p=0.85). This correlation increased to moderate significant correlation in the second day (r =0.50, p=0.00) then it became a strong significant correlation in the third day (r =0.76, p=0.00). On contrary, the respiratory improvement in the control group did not significantly correlate to the use of incentive spirometry in the first postoperative day (r =0.021, p=0.93). There was a significant weak correlation (r =0. 0.323, p=0.01) in the second postoperative day, that improved to only significant moderate correlation in the third postoperative day (r =0.508, p=0.04).
It was noted that the use of incentive spirometry program is significantly associated with decreasing the probabilities of altered gas exchange parameters which are PH (odds ratio= 0.033, p=0.01), PaCO2 (odds ratio= 0.033, p=0.01), PaO2 (odds ratio= 0.033, p=0.01), SaO2 (odds ratio= 0.033, p=0.01) and hypoxic index (odds ratio= 0.033, p=0.01) than the control group.
The use of incentive spirometry program is significantly associated with decreased probability of increased respiratory rate above normal value (Odds ratio= 0.560, p=0.000), maximum inspiratory volume (Odds ratio= -3.000, p=0.000), dyspnea (Odds ratio= 0.520, p=0.000) and breath sound (Odds ratio= -0.320, p=0.000) than the control group. Unlike the previous results, there was no significance association with the use of accessory muscles (Odds ratio= 0.90, p=0.657) than the control group.
Patients’ demographic characteristics of age and gender did not significantly (P= 0.187) affected patient respiratory outcomes. Patient clinical diagnosis (cardiovascular, respiratory, renal) significantly (P= 0.000) affected patient respiratory outcomes, unlike neurological, gastrointestinal and endocrine clinical diagnosis not significantly (P=0.362, P=0.075 and P=0.695) affected patient respiratory outcomes. The type of operation did not significantly (P=0.597) affected patient respiratory outcomes, unlike the patient length of stay which significantly (P=0.027) affected patient respiratory outcomes.
The conclusion:
The use incentive spirometry program after cardiac surgery improves patients’ respiratory outcomes which include respiratory rate, the use of accessory muscles, dyspnea, breath sound, maximum inspiratory volume, arterial blood gases and reduce the need for oxygen therapy and also it improvescardiovascular parameters as patients’ heart rate, blood pressure and central venous pressure.Use of incentive spirometer program is a cost effective intervention; it reduces patients’ length of stay.
The recommendations:
Theincentive spirometry program should be demonstratedimmediately after extubation.Educate surgical intensive care nurses about the correct use of incentive spirometry.Conduct teaching programs to raise awareness of surgical intensive care nurses about postoperative pulmonary complications and the importance of using incentive spirometry to prevent it. Establish a policy about the routine use of incentive spirometry for cardiac surgical patients.Moreover additional researches are needed to assess the effect of incentive spirometry.