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How InSee Works

The InSee is a patented incentive spirometer smart accessory that quantitatively tracks patient usage of Vyaire Medical’s AirLife incentive spirometer. 

 

Quantification of patient usage includes spirometer attempts, successes, and volumetric goals when a patient uses the incentive spirometer.

 

The InSee uses an infrared sensor, which monitors the movement of the spirometer’s internal cylinder. The cylinder contains a piston whose movement measures the volume of air that is inhaled. Using time-of-flight calculations, cylinder movement is converted to tidal volume, which is the volume of air moved with each breath and is a key marker of respiratory function. The data the InSee device collects is stored and is displayed on the bottom of the InSee. 

 

A healthcare practitioner sets a target tidal volume for the patient before use. While sitting upright, the patient puts the mouthpiece of the incentive spirometer in their mouth and closes their lips tightly around it. The patient then slowly exhales and inhales as deeply as possible. The patient must breathe through their mouth or else the spirometer and InSee device will not function. As the patient uses the spirometer, the InSee measures the tidal volume and determines how many times a patient failed to reach the target tidal volume that was programmed in the InSee. It also determines the maximum tidal volume the patient was able to reach, with an alarm indicating success. 

 

In addition, there is a set timer internal to the InSee that reminds the patient to use the spirometer and InSee via a blinking red LED and alarm that activates every 10 minutes (which can be adjusted by the healthcare provider). This alarm stops once the patient uses the spirometer and InSee. Lastly, there is an option that can be set where a blinking green LED and a success alarm activate when a “goal” is met. This alarm of success is different than the alarm of inactivity.

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Proven Methods to Improve Incentive Spirometry
Incorporating Smart Patient Reminders & Objective Monitoring

One of the primary challenges with Incentive Spirmetery is ensuring patient compliance with the therapy. Patients are required to use their incentive spirometers five to ten times an hour by taking deep breaths and sustaining certain lung volumes. Clinical studies have demonstrated that incorporating patient reminders with incentive spirometry and monitoring patient usage can improve patient adherence and outcomes.

Clinically Proven
Adding Patient Reminder Alarms to Incentive Spirometry Improved Patient Outcomes 

In a 2019 study published in Jama Surgery, adding a reminder alarm to incentive spirometry showed to improve post-cardiac surgery patients' outcomes. In this randomized clinical trial 160 participants, who underwent nonelective CABG, were randomized, with 145 completing the study per protocol. A use-tracking, IS add-on device with an integrated use reminder bell recorded and timestamped participants’ inspiratory breaths. Patients were randomized by hourly reminder “bell-on” (experimental group) or “bell-off” (control group). With 74 (51.0%) in the bell-off group and 71 in the bell-on group. 

 

The incentive spirometer reminder improved patient adherence, atelectasis severity, early postoperative fever duration, noninvasive positive pressure ventilation use, ICU and length of stay, and 6-month mortality in certain patients. With the reminder, IS appears to be clinically effective when used appropriately. Detailed outcomes are as follows: 

 

  • Improved mean daily inspiratory breaths (35.4 vs 17.1;P < .001)

  • Reduced mean atelectasis severity (1.5 vs 1.8; P = .04)

  • Reduced noninvasive positive pressure ventilation use rates (37% vs 19%; P = .03)²

  • Reduced pneumonia (5%vs 1%; P = .18)

  • Reduced postoperative length of stay (7 vs 6 days; P = .048)²

  • Reduced the ICU length of stay (4 vs 3 days; P = .02)²

  • Reduced deaths at 6 months (0%vs 9%; P = .048)²

  • Reduced fever duration (3.2 hours; 95%CI, 2.3-4.6 vs 5.2 hours; 95%CI, 3.9-7.0; P = .04).

 

 

Nurse-guided Use of Incentive Spirometry Improved Patient Outcomes 

Nurse-guided use of Incentive Spirometry reduces the risk of post-pulmonary complications and hospital length of stay after cardiac surgery. In a 2020 study published in the International Journal of Nursing Practice, a total of 89 patients were randomized into either control or intervention groups. Patients in the intervention group received bi-hourly nurse-guided incentive spirometry for 48-h postextubation. Patients in the intervention group had a significantly lower mean number of hypoxic events with shorter duration and shorter lengths of stay in the hospital and the ICU.

 

Detailed outcomes are as follows: 

  • Reduced number of Hypoxic events: 9.4 vs 30.9, P<0.001

  • Reduced duration of Hypoxic events: 36min vs 176min , P<0.001

  • Reduced post-op Hospital length of stay: 8.6 vs 12, P= 0.02

  • Reduced post-op ICU length of stay 1.8 vs 12., P<0.001

  • Reduced incidents of Pneumonia: 17.9% vs 2.6%
     

CASE STUDY: 300% Improvement 
InSee shown to improve max tidal volume in patient hospitalized with Septic Shock

Hospital: River Oak Hospital. Houston, TX

 

Background: A male patient had been hospitalized due to Septic Shock at River Oak Hospital for ten days. Despite all efforts with regular Incentive Spirometry (IS), the patient’s Max Tidal Volume remained at 500cc using the Incentive Spirometer (IS) alone. On the day the InSee was introduced to the Respiratory Care department, one of the Respiratory Therapists suggested starting this patient on InSee immediately. 

 

Results: Within two days of IS+InSee, the patient’s Max Tidal Volume increased to 750cc and within four days it reached 1500cc

 

Observation: The InSee reminder engaged the patient, caregivers, nurses, & techs to reinforce IS usages which resulted in significant improvement in Max Tidal Volume. In addition to improved breathing, the patient’s mood consciously improved. Continuous improvement, positive re-enforcement, and engagement helped the patient’s overall health and motivation.

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What is an incentive spirometer?

An incentive spirometer is a handheld medical device that measures the volume of your breath. It helps your lungs recover after surgery or lung illness, keeping them active and free of fluid.  A piston rises inside the device to measure your breath volume when you breathe from an incentive spirometer. A healthcare professional can set a target breath volume for you to hit.  Spirometers are commonly used at hospitals after surgeries or prolonged illnesses that lead to extended bed rest. Your doctor or surgeon may also give you a take-home spirometer after surgery.  In this article, we’re going to look at who might benefit from using an incentive spirometer, break down how spirometers work, and explain how to interpret the results.

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Who needs an incentive spirometer?

Breathing slowly with a spirometer allows your lungs to inflate fully. These breaths help break up fluid in the lungs that can lead to pneumonia if it’s not cleared.  An incentive spirometer is often given to people who’ve recently had surgery, people with lung disease, or people with conditions that fill their lungs with fluid.  Here’s more information:  

 

1. After surgery. An incentive spirometer can keep the lungs active during bed rest. Keeping the lungs active with a spirometer is thought to lower the risk of developing complications like atelectasis, pneumonia, bronchospasms, and respiratory failure. Pneumonia. Incentive spirometry is commonly used to break up mucus buildup that builds up in the lungs in people with pneumonia. 

 

2. Respiratory conditions like Chronic obstuctive pulmonary disease (COPD). Cystic fibrosis, or COVID-19. 

How to use an incentive spirometer

Your doctor, surgeon, or nurse will likely give you specific instructions on using your incentive spirometer. The following is the general protocol:  Sit up on the edge of your bed or chair. Hold the incentive spirometer in an upright position. Breathe out normally. Place the spirometer mouthpiece in your mouth and close your lips tightly around it. Breathe in through your mouth as slowly and deeply as you can, causing the piston or ball to rise toward the top of the chamber. Hold your breath for 3–5 seconds or as long as possible. If the spirometer has a goal indicator, use this to guide your breathing. If the indicator goes above the marked areas, slow your breathing down. Remove the mouthpiece from your mouth. Breathe out normally. The piston or ball will return to the bottom of the chamber. Rest for a few seconds, then repeat the steps 10 or more times. Go slowly. Take some normal breaths between deep breaths to prevent light-headedness. Do this every 1–2 hours when you’re awake. After each set of 10 deep breaths, cough a few timesto clear your lungs. After each set of 10 breaths, it’s a good idea to cough to cleanse your lungs of any mucus buildup. You can also clear your lungs throughout the day with relaxed breathing exercises like the below:  Relax your face, shoulders, and neck, and put one hand on your stomach. Exhale as slowly as possible through your mouth. Breathe in slowly and deeply while keeping your shoulders relaxed. Repeat four or five times per day. 

Setting incentive spirometer goals

Setting incentive spirometer goals Next to the central chamber of your spirometer is a slider. This slider can be used to set a target breath volume. Your doctor will help you set an appropriate goal based on your age, health, and condition.  You can write down your score each time you use your spirometer. This can help you track your progress over time and also help your doctor understand your progress.

What is success with spirometery?

The main column of your incentive spirometer has a grid with numbers. These numbers are usually expressed in millimeters and measure the total volume of your breath.  The piston in the main chamber of the spirometer rises upward along the grid as you breathe in. The deeper your breath, the higher the piston rises. Next to the main chamber is an indicator that your doctor can set as a target.  There’s a smaller chamber on your spirometer that measures the speed of your breath. This chamber contains a ball or piston that bobs up and down as the speed of your breath changes.  The ball will go to the top of the chamber if you’re breathing in too quickly and will go to the bottom if you’re breathing too slowly.  Many spirometers have a line on this chamber to indicate the optimal speed.

Incentive spirometer benefits

ResearchTrusted Source has found conflicting results on the effectiveness of using an incentive spirometer compared with other lung strengthening techniques.  Many of the studies looking at potential benefits were poorly designed and not well organized. But there’s at least some evidence it may help with:  improving lung function reducing mucus buildup strengthening lungs during extended rest lowering the chance of developing lung infections But a randomized controlled trial from 2019Trusted Source showed that incentive spirometers could be used to prevent pulmonary complications in rib fracture patients.

Postoperative pulmonary complications

Postoperative pulmonary complications are reported in the range of 2–39%,1,2 and include atelectasis, pneumonia, and respiratory failure. Upper-abdominal surgical procedures are associated with a higher risk of complications, followed by lower-abdominal surgery and thoracic surgery. Preoperative and postoperative respiratory therapy aims to prevent or reverse atelectasis and improve airway clearance.3 The risk and severity of complications can be reduced by the use of therapeutic maneuvers that increase lung volume. Incentive spirometry has been routinely considered a part of the perioperative respiratory therapy strategies to prevent or treat complications. Incentive spirometry is designed to mimic natural sighing or yawning by encouraging the patient to take long, slow, deep breaths. This decreases pleural pressure, promoting increased lung expansion and better gas exchange. When the procedure is repeated on a regular basis, atelectasis may be prevented or reversed.4-6 Expiratory maneuvers such as positive expiratory pressure (PEP) and vibratory PEP do not mimic the sigh. While incentive spirometry is widely used clinically as a part of routine prophylactic and therapeutic regimens in perioperative respiratory therapy, its clinical efficacy remains controversial.7

Incentive spirometry, also referred to as sustained maximal inspiration, is accomplished by using a device that provides feedback when the patient inhales at a predetermined flow or volume and sustains the inflation for at least5 seconds. The patient is instructed to hold the spirometer in an upright position, exhale normally, and then place the lips tightly around the mouthpiece. The next step is a slow inhalation to raise the ball (flow-oriented) or the piston/ plate (volume-oriented) in the chamber to the set target. At maximum inhalation, the mouthpiece is removed, followed by a breath-hold and normal exhalation. Instruction of parents, guardians, and other health caregivers in the technique of incentive spirometry may help to facilitate the patient’s appropriate use of the technique and assist with encouraging adherence to therapy.

The usefulness of prophylactic respiratory therapy, including incentive spirometry, for the prevention of clinically relevant postoperative pulmonary complications is controversial. 3.1 The effectiveness of incentive spirometry may depend on patient selection, careful instruction, and supervision during respiratory training. 3.1.1 Inadequate training and insufficient self-administration of incentive spirometry may result in a lack of resolution of postoperative complications.

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