Supervised vs Non-Supervised Incentive Spirometry After CABG

Coronary artery bypass graft (CABG) surgery is associated with an increased risk of postoperative pulmonary complications, such as atelectasis, pneumonia, and pleural effusion, which may impair pulmonary function. Incentive spirometry (IS) is commonly used as part of postoperative care to promote deep breathing, enhance alveolar recruitment, and improve lung volumes.

This quasi-experimental study is conducted at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, and enrolls patients who have undergone CABG surgery. Participants are consecutively assigned to one of two intervention groups: supervised incentive spirometry (SIS) or unsupervised incentive spirometry (Non-SIS).

Participants in the SIS group perform incentive spirometry exercises under direct supervision by healthcare personnel twice daily to ensure correct technique and adherence. Participants in the Non-SIS group perform the same exercises independently with routine reminders. Both groups receive a standardized postoperative cardiac rehabilitation program.

Pulmonary function is assessed using a portable spirometer measuring forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and peak expiratory flow (PEF). Measurements are conducted at 24 hours post-extubation (T1) and after three days of incentive spirometry exercises (T2). The primary objective is to compare changes in pulmonary function parameters between the supervised and unsupervised groups.

Inclusion criteria

• Adult patients aged ≥18 years.
• Patients who have undergone Coronary Artery Bypass Graft (CABG) surgery.
• Mechanical ventilation <24 hours post-surgery.
• Physically able to perform incentive spirometry (IS) exercises.
• Signed informed consent to participate in the study.

Exclusion criteria

• Hemodynamically unstable patients.
• Patients with cognitive or communication impairments.
• Oral abnormalities that prevent the use of IS.
• Patients with Chronic Obstructive Pulmonary Disease (COPD).
• Patients with thoracic anomalies.
• Patients who required reintubation.
• History of incentive spirometry use within the last 3 months.