INCENTIVE SPIROMETRY: THE THREE BALL TRIDENT IN ONCO ANESTHESIA

INCENTIVE  SPIROMETRY: THE  THREE BALL  TRIDENT IN ONCO ANESTHESIA

INTRODUCTION: 

The routine respiratory therapy used in our oncology setup. The basic three balls spirometer just works wonder in avoiding unnecessary complications perioperatively, reduces the morbidity rate and decrease the hospital costs to patients. This is not just useful in lung cancer patients but indeed effectively works efficiently on all onco - surgeries, and also patients in onco- critical care with poor respiratory compliance.

Discussion:

Incentive spirometer is designed to promote lung expansion by having the patient achieve a maximal inspiratory effort and, more important, one that is sustained. There are many techniques, but most commonly it is used with some visual feedback system incorporated into the device, such as raising a disc or a ball that the patient's effort controls. 

How to use incentive spirometer: 

1. Use the spirometer always through your mouth
2. Sit upright and hold the spirometer at the eye level.
3. Put the mouthpiece in your mouth and close your lips tightly.
4. Breathe out slowly and fully.
5. The deeper you breathe in the piston raises more effectively.
6. Hold the breath for 3- 5 seconds.
7. Then slowly release out breath
8. Rest for a few seconds and repeat it.

It is inexpensive, portable, and convenient to use as it can be used at the patient's bedside or taken on transport. When used 10 times every hour while the patient is awake, it has been shown to reduce pulmonary complications after major oncology surgeries. 

There are typically two types of incentive spirometer, namely:

• Flow-oriented incentive spirometer (Triflow Device) -   Has three chambers with one ball in each chamber. Capacity up to 1200ml.
• Volume-oriented incentive spirometer -    Has one-way valve with capacity up to 4000 ml. Current evidence tells us that using this type of spirometer requires lesser work of breathing and improves diaphragmatic function

INDICATIONS: 

• Pre-operative screening of patients at risk of postoperative complications to obtain a baseline of their inspiratory flow and volume
• Presence of pulmonary atelectasis
• Conditions predisposing to atelectasis such as:

• Restrictive lung disease associated with a dysfunctional diaphragm or involving respiratory system
• Patients with inspiratory capacity less than 2.5 liters
• Patients with neuromuscular disease.

The Contra-indications are:

• Patients who cannot use the device appropriately or require supervision at all times
• Patients who are noncompliant or do not understand or demonstrate proper use of the device
• Very young patients or pediatrics with developmental delay.
• Hyperventilation
• Hypoxemia secondary to interruption of oxygen therapy
• Fatigue
• Patients unable to take deep breath effectively due to pain, diaphragmatic dysfunction, or opiate analgesia.
• Patients who are heavily sedated or comatose.

Routine evidential practices of incentive Spirometry in Oncology:

1. Major abdominal surgeries: May be HIPEC / Cytoreductive surgeries/  Exploratory laparotomy / Gastrectomy/ Hepatectomy or staging laparotomy incentive spirometry has shown promising results in decreasing post op pulmonary complications, reducing oxygen requirement, less number of hospital stay and low hospital costs.

1. Thoracic surgeries: The use of IS for patients with lung cancers undergoing surgical resection via VATS is beneficial in lowering hospitalization costs and decreasing the incidence of pneumonia occurrence. Conventional physiotherapy and early ambulation have shown amplified results which help in early recovery of patients.
2. ONCO CRITICAL CARE: This aspect is a commonly neglected part in oncology. But, it's important from our side to deliver a good quality of life even to terminal patients. Its routinely said “ Every life and Every single Day matters”. Most commonly patients with hematologic malignancy, patients with febrile neutropenia, often receive higher end antibiotics. These managements could affect lung compliance and can further deteriorate the further course even after counts and febrile sepsis has come down. Early initiation of incentive spirometry can decrease the morbidity in these conditions and improve the survival rate.

1. ONCO SURGERIES WHERE SPIROMETER IS CONTRAINDICATED: Few surgeries like Oral cancer surgeries, hemiglossectomy, buccal mucosa cancer, thyroid surgeries,lip cancer surgeries are few surgeries where the usage of incentive spirometer is not feasible.

PREOPERATIVE INITIATION: 

                                           Preoperative incentive spirometry for atleast two days prior to surgery along with the exercise of deep breathing, encouraged coughing, and early ambulation following Oncosurgeries are in connection with prevention and decreased incidence of atelectasis, hospital stay, mechanical ventilation duration and improved postoperative oxygenation with better pain control.

CONCLUSION: 

                               Incentive spirometers are used for diagnostic and therapeutic purposes in Oncosurgeries. The Trident ball can work wonders by decreasing postoperative pulmonary infections and further decreasing the hospital stay as well as hospital costs in patients undergoing major Oncosurgeries.