THE EFFECT OF INCENTIVE SPIROMETRY AND OSCILLATORY POSITIVE EXPIRATORY PRESSURE THERAPIES ON FUNCTIONAL CAPACITY, DYSPNEA, AND SATURATION IN BURN PATIENTS WITH INHALATION INJURY: A RANDOMIZED CONTROLLED STUDY
Year 2024,
, 57 - 61, 23.08.2024
Murat Ali Çınar
,
Kevser Göksu Başarici
,
Aleyna Sarıkaya
,
Kezban Bayramlar
,
Ahmet Erkiliç
,
Yavuz Yakut
Abstract
Objective: The aim of this study is to investigate the effects of incentive spirometry (Triflo) and oscillatory positive expiratory pressure therapy (use of Acapella) in addition to standard pulmonary physiotherapy exercises on functional capacity, dyspnea, and saturation levels in burn patients with inhalation injury.
Method: A total of 24 patients hospitalized in the intensive care and service units of the Gaziantep City Hospital Burn Center were included in the study. Patients were divided into three groups using stratified randomization method. The first group received standard physiotherapy exercises in addition to medical and surgical treatment, the second group received incentive spirometry (Triflo) in addition to this standard treatment, and the third group received standard treatment+oscillatory positive expiratory pressure therapy (Acapella). All groups were followed for 4 weeks. Six-minute walk test (6MWT), dyspnea modified medical research council (MMRC) scale, and saturation values were compared for all groups before and after treatment.
Results: A total of 24 patients, 22 males and 2 females, aged 19-63 (38.66±16.77), were included in the study. When the initial and final week measurements of the six-minute walk test, dyspnea scale (MRC), and saturation values of all groups were compared, no difference was found (p>0.05).
Conclusion: Oscillatory positive expiratory pressure therapy (Acapella Use) and incentive spirometry (Triflo) can be given in addition to standard physiotherapy exercises in burn patients with inhalation injury. These exercises are equally effective in the functional capacity, dyspnea, and saturation levels of burn patients with inhalation injury.
Ethical Statement
The study received approval from the Non-Interventional Research Ethics Committee of Hasan Kalyoncu University, Faculty of Health Sciences, with approval number 2024/13 dated 19.02.2024. Informed consent forms, detailing the purpose and content of the study, were provided to each participant who is a citizen of the Republic of Turkey, and information was also provided to foreign nationals through interpreters. Participants who agreed to participate in the study confirmed their participation by signing the voluntary informed consent form.
Supporting Institution
The Scientific And Technological Research Council Of Türkiye (Tübitak) (2209- Project number: 1919B012215284)
Project Number
1919B012215284
References
- Dyamenahalli K, Garg G, Shupp JW, Kuprys PV, Choudhry MA, Kovacs EJ. Inhalation injury: unmet clinical needs and future research. J Burn Care Res. 2019;40(5):570-584.
- Jones SW, Williams FN, Cairns BA, Cartotto R. Inhalation injury: pathophysiology, diagnosis, and treatment. Clin Plast Surg. 2017;44(3):505-511.
- Reid A, Ha JF. Inhalational injury and the larynx: A review. Burns. 2019;45(6):1266-1274.
- You K, Yang HT, Kym D, Yoon J, Cho YS, Hur J, Kim JH. Inhalation injury in burn patients: establishing the link between diagnosis and prognosis. Burns. 2014;40(8):1470-1475.
- Merrel P, Mayo D. Inhalation injury in the burn patient. Crit Care Nurs Clin. 2004;16(1):27-38.
- Gupta K, Mehrotra M, Kumar P, Gogia AR, Prasad A, Fisher JA. Smoke inhalation injury: etiopathogenesis, diagnosis, and management. Indian J Crit Care Med. 2018;22(3):180.
- Won YH, Cho YS, Joo SY, Seo CH. Respiratory characteristics in patients with major burn injury and smoke inhalation. J Burn Care Res. 2022;43(1):70-76.
- Özkal Ö, Topuz S, Karahan S, Erdem MM, Konan A, Yastı AÇ. Clinical predictors of pulmonary functions, respiratory/peripheral muscle strength and exercise capacity at discharge in adults with burn injury. Disabil Rehabil. 2021;43(20):2875-2881.
- El-Sayed Attalla AF, Ahmed KT, Abd El Monem M. Effects of Inspiratory Muscle Training on Clinical Predictors of Respiratory Muscle Strength and Lung Function in Burned Patients with Inhalation Injury. Journal of Burn Care & Research. 2023;44(1):140-145.
- Börekçi Ş, Gemicioğlu B, Görek Dilektaşlı A, Kıyan E, Köktürk N, Ulubay G, YILDIZ Ö. Türk Toraks Derneği Akciğer Difüzyon Kapasitesi Değerlendirme Uzlaşı Raporu.
- Krzywiecki A, Ziora D, Niepsuj G, Jastrzebski D, Dworniczak S, Kozielski J. Late consequences of respiratory system burns. J Physiol Pharmacol. 2007;58:319-325.
- Mlcak R, Desai MH, Robinson E, Nichols R, Herndon DN. Lung function following thermal injury in children—an 8-year follow up. Burns. 1998;24:213-216.
- Eltorai AE, Szabo AL, Antoci V, Ventetuolo CE, Elias JA, Daniels AH, Hess DR. Clinical effectiveness of incentive spirometry for the prevention of postoperative pulmonary complications. Respir Care. 2018;63(3):347-352.
- Chang PC, Chen PH, Chang TH, Chen KH, Jhou HJ, Chou SH, Chang TW. Incentive spirometry is an effective strategy to improve the quality of postoperative care in patients. Asian J Surg. 2023;46(9):3397-3404.
- Kotta PA, Ali JM. Incentive spirometry for prevention of postoperative pulmonary complications after thoracic surgery. Respir Care. 2021;66(2):327-333.
- Demchuk AM, Chatburn RL. Performance characteristics of positive expiratory pressure devices. Respir Care. 2021;66(3):482-493.
- Alghamdi SM, Alsulayyim AS, Alasmari AM, Philip KE, Buttery SC, Banya WA, Hopkinson NS. Oscillatory positive expiratory pressure therapy in COPD (O-COPD): a randomised controlled trial. Thorax. 2023;78(2):136-143.
- Kang M, Ragan BG, Park JH. Issues in outcomes research: an overview of randomization techniques for clinical trials. J Athl Train. 2008;43(2):215-221.
- Hettiaratchy S, Papini R. Initial management of a major burn: I-overview. BMJ. 2004;328(7455):1555-1557.
- Çınar MA, Bayramlar K, Erkılıç A, Güneş A, Yakut Y. The effects of early physiotherapy on biochemical parameters in major burn patients: A burn center’s experience. Turk J Trauma Emerg Surg. 2019;25(5):461-466.
- Nelson ME, Rejeski WJ, Blair SN, Duncan PW, Judge JO, King AC, et al. Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Circulation. 2007;116(9):1094.
- Chan WL, Pin TW. Reliability, validity and minimal detectable change of 2-minute walk test, 6-minute walk test and 10-meter walk test in frail older adults with dementia. Experimental gerontology. 2019;115:9-18.
- Richards JB. Calculated decisions: mMRC (modified Medical Research Council) dyspnea scale. Emergency medicine practice. 2017;19(Suppl 10):1-2.
- Portney LG, Watkins MP. Foundations of clinical research: applications to practice. Upper Saddle River, NJ: Pearson/Prentice Hall; 2009.
- Cohen J. Statistical Power Analysis for the Behavioral Sciences (2nd ed.).1988.
- Malik SS, Tassadaq N. Effectiveness of deep breathing exercises and incentive spirometry on arterial blood gases in second degree inhalation burn patients. J Coll Physicians Surg Pak. 2019;29(10):954-957.
- Abazarnejad E, Froutan R, Ahmadabadi A, Mazlom SR. Improving respiratory muscle strength and health status in burn patients: a randomized controlled trial. Qual Life Res. 2022;1-8.
- Malik SS, Saeed S, Kanwal S. Effect of deep breathing exercises and incentive spirometry on respiratory distress scoring in second degree inhalational burn patients. J Shifa Tameer-e-Millat Univ. 2019;2(1):13-16.
- Zerang F, Amouzeshi A, Barkhordari-Sharifabad M. Comparison of the effect of incentive spirometry and deep breathing exercises on hemodynamic parameters of patients undergoing coronary artery bypass graft surgery: A Clinical Trial. J Vasc Nurs. 2022;40(3):134-139.
- Sweity EM, Alkaissi AA, Othman W, Salahat A. Preoperative incentive spirometry for preventing postoperative pulmonary complications in patients undergoing coronary artery bypass graft surgery: a prospective, randomized controlled trial. J Cardiothorac Surg. 2021;16(1):241.
- Bhosale DA, Agarwal B, Murkudkar P, Bagwe H. Using Incentive Spirometer to Improve Lung Function in Patients With Chronic Lung Disease: A Patient Guide. Arch Phys Med Rehabil. 2023;104(9):1557-1560.
- Gugnani A. Effects of breathing exercises and incentive spirometry in improving lung capacity on individuals with lung fibrosis. Eur J Mol Clin Med. 2020;1407-1435.
- Tse J, Wada K, Wang Y, Coppolo D, Kushnarev V, Suggett J. Impact of oscillating positive expiratory pressure device use on post-discharge hospitalizations: a retrospective cohort study comparing patients with COPD or chronic bronchitis using the Aerobika® and Acapella® devices. Int J Chron Obstruct Pulmon Dis. 2020;15:2527-2538.
- Tayade V, Vardhan V. The Effect of Aerobika Device and Acapella Device on Rehospitalisation and Pulmonary Functions in Patients with Chronic Obstructive Pulmonary Disease-A Systematic Review. J Clin Diagn Res. 2023;17(7).
Year 2024,
, 57 - 61, 23.08.2024
Murat Ali Çınar
,
Kevser Göksu Başarici
,
Aleyna Sarıkaya
,
Kezban Bayramlar
,
Ahmet Erkiliç
,
Yavuz Yakut
Project Number
1919B012215284
References
- Dyamenahalli K, Garg G, Shupp JW, Kuprys PV, Choudhry MA, Kovacs EJ. Inhalation injury: unmet clinical needs and future research. J Burn Care Res. 2019;40(5):570-584.
- Jones SW, Williams FN, Cairns BA, Cartotto R. Inhalation injury: pathophysiology, diagnosis, and treatment. Clin Plast Surg. 2017;44(3):505-511.
- Reid A, Ha JF. Inhalational injury and the larynx: A review. Burns. 2019;45(6):1266-1274.
- You K, Yang HT, Kym D, Yoon J, Cho YS, Hur J, Kim JH. Inhalation injury in burn patients: establishing the link between diagnosis and prognosis. Burns. 2014;40(8):1470-1475.
- Merrel P, Mayo D. Inhalation injury in the burn patient. Crit Care Nurs Clin. 2004;16(1):27-38.
- Gupta K, Mehrotra M, Kumar P, Gogia AR, Prasad A, Fisher JA. Smoke inhalation injury: etiopathogenesis, diagnosis, and management. Indian J Crit Care Med. 2018;22(3):180.
- Won YH, Cho YS, Joo SY, Seo CH. Respiratory characteristics in patients with major burn injury and smoke inhalation. J Burn Care Res. 2022;43(1):70-76.
- Özkal Ö, Topuz S, Karahan S, Erdem MM, Konan A, Yastı AÇ. Clinical predictors of pulmonary functions, respiratory/peripheral muscle strength and exercise capacity at discharge in adults with burn injury. Disabil Rehabil. 2021;43(20):2875-2881.
- El-Sayed Attalla AF, Ahmed KT, Abd El Monem M. Effects of Inspiratory Muscle Training on Clinical Predictors of Respiratory Muscle Strength and Lung Function in Burned Patients with Inhalation Injury. Journal of Burn Care & Research. 2023;44(1):140-145.
- Börekçi Ş, Gemicioğlu B, Görek Dilektaşlı A, Kıyan E, Köktürk N, Ulubay G, YILDIZ Ö. Türk Toraks Derneği Akciğer Difüzyon Kapasitesi Değerlendirme Uzlaşı Raporu.
- Krzywiecki A, Ziora D, Niepsuj G, Jastrzebski D, Dworniczak S, Kozielski J. Late consequences of respiratory system burns. J Physiol Pharmacol. 2007;58:319-325.
- Mlcak R, Desai MH, Robinson E, Nichols R, Herndon DN. Lung function following thermal injury in children—an 8-year follow up. Burns. 1998;24:213-216.
- Eltorai AE, Szabo AL, Antoci V, Ventetuolo CE, Elias JA, Daniels AH, Hess DR. Clinical effectiveness of incentive spirometry for the prevention of postoperative pulmonary complications. Respir Care. 2018;63(3):347-352.
- Chang PC, Chen PH, Chang TH, Chen KH, Jhou HJ, Chou SH, Chang TW. Incentive spirometry is an effective strategy to improve the quality of postoperative care in patients. Asian J Surg. 2023;46(9):3397-3404.
- Kotta PA, Ali JM. Incentive spirometry for prevention of postoperative pulmonary complications after thoracic surgery. Respir Care. 2021;66(2):327-333.
- Demchuk AM, Chatburn RL. Performance characteristics of positive expiratory pressure devices. Respir Care. 2021;66(3):482-493.
- Alghamdi SM, Alsulayyim AS, Alasmari AM, Philip KE, Buttery SC, Banya WA, Hopkinson NS. Oscillatory positive expiratory pressure therapy in COPD (O-COPD): a randomised controlled trial. Thorax. 2023;78(2):136-143.
- Kang M, Ragan BG, Park JH. Issues in outcomes research: an overview of randomization techniques for clinical trials. J Athl Train. 2008;43(2):215-221.
- Hettiaratchy S, Papini R. Initial management of a major burn: I-overview. BMJ. 2004;328(7455):1555-1557.
- Çınar MA, Bayramlar K, Erkılıç A, Güneş A, Yakut Y. The effects of early physiotherapy on biochemical parameters in major burn patients: A burn center’s experience. Turk J Trauma Emerg Surg. 2019;25(5):461-466.
- Nelson ME, Rejeski WJ, Blair SN, Duncan PW, Judge JO, King AC, et al. Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Circulation. 2007;116(9):1094.
- Chan WL, Pin TW. Reliability, validity and minimal detectable change of 2-minute walk test, 6-minute walk test and 10-meter walk test in frail older adults with dementia. Experimental gerontology. 2019;115:9-18.
- Richards JB. Calculated decisions: mMRC (modified Medical Research Council) dyspnea scale. Emergency medicine practice. 2017;19(Suppl 10):1-2.
- Portney LG, Watkins MP. Foundations of clinical research: applications to practice. Upper Saddle River, NJ: Pearson/Prentice Hall; 2009.
- Cohen J. Statistical Power Analysis for the Behavioral Sciences (2nd ed.).1988.
- Malik SS, Tassadaq N. Effectiveness of deep breathing exercises and incentive spirometry on arterial blood gases in second degree inhalation burn patients. J Coll Physicians Surg Pak. 2019;29(10):954-957.
- Abazarnejad E, Froutan R, Ahmadabadi A, Mazlom SR. Improving respiratory muscle strength and health status in burn patients: a randomized controlled trial. Qual Life Res. 2022;1-8.
- Malik SS, Saeed S, Kanwal S. Effect of deep breathing exercises and incentive spirometry on respiratory distress scoring in second degree inhalational burn patients. J Shifa Tameer-e-Millat Univ. 2019;2(1):13-16.
- Zerang F, Amouzeshi A, Barkhordari-Sharifabad M. Comparison of the effect of incentive spirometry and deep breathing exercises on hemodynamic parameters of patients undergoing coronary artery bypass graft surgery: A Clinical Trial. J Vasc Nurs. 2022;40(3):134-139.
- Sweity EM, Alkaissi AA, Othman W, Salahat A. Preoperative incentive spirometry for preventing postoperative pulmonary complications in patients undergoing coronary artery bypass graft surgery: a prospective, randomized controlled trial. J Cardiothorac Surg. 2021;16(1):241.
- Bhosale DA, Agarwal B, Murkudkar P, Bagwe H. Using Incentive Spirometer to Improve Lung Function in Patients With Chronic Lung Disease: A Patient Guide. Arch Phys Med Rehabil. 2023;104(9):1557-1560.
- Gugnani A. Effects of breathing exercises and incentive spirometry in improving lung capacity on individuals with lung fibrosis. Eur J Mol Clin Med. 2020;1407-1435.
- Tse J, Wada K, Wang Y, Coppolo D, Kushnarev V, Suggett J. Impact of oscillating positive expiratory pressure device use on post-discharge hospitalizations: a retrospective cohort study comparing patients with COPD or chronic bronchitis using the Aerobika® and Acapella® devices. Int J Chron Obstruct Pulmon Dis. 2020;15:2527-2538.
- Tayade V, Vardhan V. The Effect of Aerobika Device and Acapella Device on Rehospitalisation and Pulmonary Functions in Patients with Chronic Obstructive Pulmonary Disease-A Systematic Review. J Clin Diagn Res. 2023;17(7).