The Science Journal of the American Association for Respiratory Care

2004 OPEN FORUM Abstracts


Tim Frymyer, BS, RRT, David Mussetter, BA, RRT, Mike Trevino, MS, RRT, Gary Weinstein, MD, FCCP, Presbyterian Hospital of Dallas, Dallas, Texas

Background: Post-operative fever has long been speculated by medical practitioners at our institution as an appropriate indication for the administration of incentive spirometry; even after providing literature suggesting no correlation is evident between fever and atelectasis (Engoren – Chest 107; Roberts, et el – Heart and Lung 17). We propose that by looking at length of stay (LOS), incentive spirometry (I.S.) does not provide a value-added effect for patients presenting with post-operative fever.

Retrospective chart review of 124 consecutive post gynecologic surgery patients spanning a 2-month period. Patients: Two groups were identified; those who received I.S. (107) and those who did not (17). The I.S. group of patients received incentive spirometry based on our established therapist driven protocol system. An inspiratory capacity was measured and the patient and family members were instructed on its use. Patients automatically received a respiratory therapy evaluation and incentive spirometry if the physician utilized the preprinted post-gyn surgery order form or placed any respiratory-based order on the postoperative admission order to the nursing unit. The average percent of predicted inspiratory capacity achieved was 82% with a standard deviation (sd) of 23.7%. The non-I.S. group received no therapy or respiratory evaluation. Patients entered into this group when surgeons did not utilize the standing order form for post-gyn surgeries or did not write a respiratory order on the physician order form. The average age, weight, height and length of anesthesia were similar in both groups. The 2 groups also shared similar diagnoses and surgical procedures.

Results: LOS and Tmax 24º, 48º and 72º were recorded for the two groups. The table below details the mean and standard deviation in the two groups.

  LOS Tmax 24 Tmax48 Tmax72
I.S. group 2.5 (1.08) 99.5 (0.67) 100.1 (0.72) 99.7 (0.97)
Non I.S. group 2.4 (0.79) 99.3 (0.69) 99.7 (0.72) 99.6 (0.93)

Conclusions: It is difficult to make broad conclusions from a retrospective study design, however, I believe some inferences can be put forward. The data suggest that temperature should not be a predictor for I.S. and I.S. by itself does not impact LOS in the post surgical gyn population. Continued studies with larger sample sizes and a better design are necessary to ensure we base our practice of respiratory therapy on sound science and not unproven speculation.