The Effects Incentive Spirometry Use in Coronary Artery Bypass Surgery

March 13, 2026 updated by: Esma Gökçe, Cukurova University

Outcomes of Incentive Spirometry for Patients Undergoing Coronary Artery Bypass Surgery: A Randomised Controlled Trial

Background: Incentive spirometry is used in addition to care, especially in reducing pulmonary complications after surgery. Complications in the cardiovascular and pulmonary systems can basically be determined by blood values and vital signs, which are important objective data of haemodynamics.

Aim: This study was designed to test the hypothesis that the use of incentive spirometry in conjunction with postoperative pulmonary rehabilitation care has a notable impact on arterial blood gas, oxygen saturation (SpO2), and vital signs.

Methods: This randomised, controlled trial was designed using a repeated-measures design. The study was planned to be conducted at the cardiovascular surgery clinic of a university hospital. It was intended that data from patients undergoing coronary artery bypass graft surgery would be analyzed. All patients were planned to receive routine pulmonary rehabilitation, with incentive spirometry added for the experimental group. Outcome measures were designed to include arterial blood gas values, oxygen saturation, and vital signs recorded during the postoperative period.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

This study was designed as a single-center, randomized controlled trial with repeated measures to evaluate the effects of incentive spirometry used in addition to routine postoperative pulmonary rehabilitation in patients undergoing coronary artery bypass graft surgery.

The study was planned to be conducted in the cardiovascular surgery clinic of a university hospital. Patients assessed for eligibility were to be randomized into two groups: an experimental group (receiving incentive spirometry plus routine pulmonary rehabilitation) or a control group (receiving routine pulmonary rehabilitation only).

Randomization was performed using a simple randomization method with a computer-generated random number table. Group assignments were placed in sequentially numbered sealed envelopes to ensure allocation concealment. A single-blind approach was used during randomization, where the principal investigator and the statistician remained blinded to group assignments.

In the experimental group, it was planned that patients would receive routine pulmonary rehabilitation together with incentive spirometry. The device intended for use was a flow-oriented incentive spirometer with three chambers (target volumes: 600, 900, and 1200 mL). The intervention was planned to be initiated postoperatively after extubation and continued throughout the hospital stay. The procedure involved 10 to 20 deep breaths every 1 to 2 hours, combined with coughing exercises.

The control group was planned to receive routine pulmonary rehabilitation care without incentive spirometry. This care included deep breathing and coughing exercises, pain assessment, and early mobilization. Early mobilization was planned for both groups.

Data collection was planned to be performed during the preoperative period and across the early postoperative period (Days 1, 2, and 3). Recorded variables were intended to include demographic characteristics, arterial blood gas values (PaO2, PaCO2, SaO2), peripheral oxygen saturation (SpO2), and vital signs (systolic/diastolic blood pressure, respiratory rate, and pulse rate).

Study Type

Interventional

Enrollment (Actual)

58

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 88 years (Adult, Older Adult)

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • Patients undergoing first-time, nonemergency coronary artery bypass graft surgery
  • Patients who agreed to participate in the study
  • Patients who were able to communicate

Patients with no hearing difficulty

Patients with no history of psychiatric and/or mental illness

-Patients with a stable clinical condition

Exclusion Criteria:

  • Patients with an unstable clinical condition
  • Patients who refused to participate
  • Patients with chronic obstructive pulmonary disease
  • Patients with chronic kidney failure
  • Patients with severe hemodynamic dysfunction
  • Patients requiring sternotomy or re-sternotomy
  • Patients requiring prolonged mechanical ventilation

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Prevention
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Quadruple

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
No Intervention: Control group
Participants in the control group received routine postoperative pulmonary rehabilitation care without incentive spirometry. Routine care included deep breathing exercises, coughing exercises, pain assessment and management, and early mobilization during hospitalization. Arterial blood gas parameters, peripheral oxygen saturation, and vital signs were measured and recorded during the resting period at the end of postoperative days 1, 2, and 3.
Experimental: Incentive Spirometry Group
Participants in the experimental group received routine postoperative pulmonary rehabilitation care plus incentive spirometry. Routine care included deep breathing exercises, coughing exercises, pain assessment and management, and early mobilization during hospitalization. Incentive spirometry was explained, demonstrated, and applied preoperatively and continued after extubation when the patient was fully awake. The intervention included 10 to 20 breaths every 1 to 2 hours according to patient tolerance. Arterial blood gas parameters, peripheral oxygen saturation, and vital signs were measured and recorded during the resting period at the end of postoperative days 1, 2, and 3.
Device: Incentive Spirometry Group
A flow-oriented incentive spirometer with three compartments and target volumes of 600, 900, and 1200 mL was used. Patients were instructed in its use preoperatively and continued the application after extubation when fully awake. The intervention was performed every 1 to 2 hours while awake, for a total of 10 to 20 breaths according to tolerance. Patients performed deep breathing exercises first, followed by incentive spirometry, and then coughing exercises. During the application, the bed was elevated to 45 degrees and the patient was positioned in long sitting. Patients were instructed to inhale slowly and deeply to raise the balls to the target level, hold their breath for 3 to 5 seconds, and then exhale normally. The exercise was repeated according to tolerance, and coughing exercises were performed after every five repetitions.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Partial Pressure of Oxygen (PaO2)
Time Frame: Preoperative, postoperative day 1, postoperative day 2, and postoperative day 3
Measurement of the partial pressure of oxygen (mmHg) obtained via arterial blood gas analysis to evaluate oxygenation levels.
Preoperative, postoperative day 1, postoperative day 2, and postoperative day 3
Partial Pressure of Carbon Dioxide (PaCO2)
Time Frame: Preoperative, postoperative day 1, postoperative day 2, and postoperative day 3.
Measurement of the partial pressure of carbon dioxide (mmHg) obtained via arterial blood gas analysis to evaluate ventilation efficiency.
Preoperative, postoperative day 1, postoperative day 2, and postoperative day 3.
Arterial Oxygen Saturation (SaO2)
Time Frame: Preoperative, postoperative day 1, postoperative day 2, and postoperative day 3.
Measurement of the arterial oxygen saturation percentage (%) obtained via arterial blood gas analysis.
Preoperative, postoperative day 1, postoperative day 2, and postoperative day 3.
Peripheral Oxygen Saturation (SpO2)
Time Frame: Preoperative, postoperative day 1, postoperative day 2, and postoperative day 3.
Measurement of the peripheral oxygen saturation percentage (%) using a non-invasive pulse oximetry device.
Preoperative, postoperative day 1, postoperative day 2, and postoperative day 3.

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Systolic Blood Pressure
Time Frame: Preoperative, postoperative day 1, postoperative day 2, postoperative day 3
Measurement of systolic blood pressure (mmHg) during the resting period to evaluate hemodynamic stability.
Preoperative, postoperative day 1, postoperative day 2, postoperative day 3
Change in Diastolic Blood Pressure
Time Frame: Preoperative, postoperative day 1, postoperative day 2, postoperative day 3.
Measurement of diastolic blood pressure (mmHg) during the resting period to evaluate hemodynamic stability.
Preoperative, postoperative day 1, postoperative day 2, postoperative day 3.
Change in Respiratory Rate
Time Frame: Preoperative, postoperative day 1, postoperative day 2, postoperative day 3.
Measurement of the number of breaths per minute to assess respiratory effort and function.
Preoperative, postoperative day 1, postoperative day 2, postoperative day 3.
Change in Pulse Rate
Time Frame: Preoperative, postoperative day 1, postoperative day 2, postoperative day 3.
Measurement of the number of heartbeats per minute to monitor cardiovascular response.
Preoperative, postoperative day 1, postoperative day 2, postoperative day 3.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Cukurova University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

February 15, 2021

Primary Completion (Actual)

February 15, 2022

Study Completion (Actual)

December 15, 2022

Study Registration Dates

First Submitted

December 13, 2021

First Submitted That Met QC Criteria

December 30, 2021

First Posted (Actual)

January 14, 2022

Study Record Updates

Last Update Posted (Actual)

March 17, 2026

Last Update Submitted That Met QC Criteria

March 13, 2026

Last Verified

March 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 50202081

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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