Incentive spirometry to reduce pulmonary complications after rib fractures

Incentive spirometry (IS) is a therapeutic technique to promote maximal inspiration with breathing exercises via a handheld device which gives visual feedback, with the aim of reducing pulmonary complications after surgery. A short cut review of the literature was carried out to examine whether there is evidence for the use of IS as a treatment modality to reduce complications following rib fractures. 157 unique papers were found, of which 3 (a randomised controlled trial, substudy of a prospective observational cohort study and a retrospective observational study) included data on patients relevant to the specific clinical question; these are discussed in the paper. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the best papers are tabulated. The clinical bottom line is that to date, there is not enough evidence to support the routine use of IS to reduce complications in patients who have sustained rib fractures. To answer the clinical question, a prospective study with a defined protocol of IS administration would be needed to establish if it has clinical utility in this setting.