Compare the Effect of Incentive Spirometry Versus Chest Mobilization on Oxygenation and Chest Expansion for Patient Undergoing Upper Abdominal Surgery: A Randomized Clinical Trial

The most prevalent and severe type of conditions identified after upper abdomen procedures are postoperative respiratory issues. The probability of experiencing postoperative pulmonary problems increases as the incision being made during an operation approaches the diaphragm. Upper abdominal surgical operations are associated with a 20% occurrence of postoperative pulmonary problems, while lower abdominal surgeries have a lower prevalence ranging from 2% to 8%. Percutaneous upper abdomen procedures trigger a sequence of pathological reactions that may result in postoperative pulmonary problems in older individuals. Pathological responses encompass a decline in central nervous system activity, reduced mobility of the diaphragm, impaired function of the mucociliary system, decreased effectiveness of coughing, alterations in the ventilation-perfusion ratio, increased respiratory rate, and decreased pulmonary volumes and capacities.

An incentive spirometer (IS) is a feedback device designed to motivate patients to inhale deeply and generate a prolonged maximum inspiration in order to primarily open and stabilize portions of the lung affected by atelectasis. It offers mild resistance exercise yet minimizing the risk of fatigue to the diaphragm muscle.

In the context of physical activity aimed at enhancing chest expansion and ventilation, chest mobilization method is a component. It is executed by raising the arms to their maximum extent while inhaling deliberately. The chest mobilization technique facilitates the opening of individual rib cages in the upper, middle, and lower regions of the chest wall. It also enhances the mobility of the stern costal and costovertebral joints, therefore positively impacting chest movement and ventilation .

Importance of the study Recovery following surgery may be impeded by a range of symptoms including physical discomfort, psychological distress, emotional instability, and pain. Under general anesthesia during surgery, the lungs of a patient are unable to achieve complete ventilation. The discomfort resulting from the abdominal incision hinders inhalation, therefore limiting lung expansion. Postoperative pulmonary complications (PPCs) may arise, particularly when surgery is conducted in the upper abdomen region.

Individuals suffering from chronic pain disorders may experience compromised deep breathing mechanisms. This group of patients is susceptible to respiratory impairment caused by a range of factors including pneumonia, atelectasis, bronchiectasis, sleep apnea, chronic obstructive lung disease, and restrictive lung disease. Furthermore, those who have inadequate nutritional condition, excessive salivation, aspiration, gastric reflux, compromised airway clearance caused by muscle weakness or incoordination, and insufficient pulmonary reserve are more susceptible to respiratory insufficiency, morbidity, and death.