This study aimed to investigate the effects of two types of IS devices – FIS and VIS - on improving pulmonary function and functional capacity in patients undergoing thoracoabdominal surgery.
We conducted a systematic review to evaluate published randomized controlled trials in English or Chinese that compared the two types of IS devices in patients following thoracoabdominal surgery. Our literature search encompassed six electronic databases from their inception through July 2024, including PubMed, MEDLINE, the Cochrane Library, EMBASE, Scopus, and Airiti Library. The PRISMA checklist was used to guide our review process. Initially, titles and abstracts were screened according to predefined criteria, followed by a review of full texts where available. The selection criteria included: participants aged over 18 years who had undergone thoracoabdominal surgery, intervention involving IS, comparisons between FIS and VIS, and outcome measures that comprised the 6-minute walking test (6MWT), the functional disability questionnaire (FDQ), forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and peak expiratory flow rate (PEFR). The quality of the included studies was assessed using the Physiotherapy Evidence Database (PEDro) scale. Meta-analysis was performed utilizing RevMan Web to synthesize the results quantitatively.
A total of seven studies involving 687 patients met our inclusion criteria, with 101 participants undergoing cardiac surgery (n = 2 studies), and 586 participants undergoing abdominal surgery (n = 5 studies). The quality appraisal assessed using the PEDro scale, yielded a mean score of 5.7 out of 10 points (range: 4-8/10), indicating a generally low quality of evidence. The meta-analysis demonstrated a significant improvement in the 6MWT (mean difference: 37.63 meters, 95% CI = 13.4 – 61.86 meters) and FDQ (mean difference: -38.43 point, 95% CI = -50.25 – -26.6 point) in the VIS group compared to the FIS group for patients undergoing cardiac surgery. Furthermore, in the cohort of patients who underwent abdominal surgery, significant improvements in pulmonary function were observed, with FVC increasing by 0.20 liters (95% CI= 0.05-0.36 liters), FEV1 improving by 0.22 liters (95% CI= 0.06-0.38 liters), and PEFR increasing by 0.54 liters (95% CI= 0.09-0.98 liters) in the VIS group relative to the FIS group.
In patients undergoing thoracoabdominal surgery, using VIS may enhance recovery in both functional capacity and pulmonary function compared to FIS.
Given its ability to closely replicate natural deep breathing patterns, the implementation of VIS is recommended postoperatively to effectively address the decline in functional capacity and pulmonary function commonly observed after thoracoabdominal surgery.
pulmonary function
thoracoabdominal surgery
