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Indian J Crit Care Med
Indian J Crit Care Med
IJCCM
Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine
0972-5229
1998-359X
Jaypee Brothers Medical Publishers

10.5005/jp-journals-10071-24712
Letter to the Editor
A Simple Adaptation for the Convenient Application of Incentive Spirometry in Tracheostomized Critically Ill Patients
Arasu Meenupriya 1https://orcid.org/0000-0002-2744-8716

Singh Akhil Kant 2https://orcid.org/0000-0002-6662-9819

LaguduvaH Akshay 3https://orcid.org/0009-0008-3172-5190

1–3 Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
Meenupriya Arasu, Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India, Phone: +91 7708024354, e-mail: meenupriya1193@gmail.com
5 2024
30 4 2024
28 5 520521
Copyright © 2024; The Author(s).
2024
https://creativecommons.org/licenses/by-nc/4.0/ © The Author(s). 2024 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
How to cite this article: Arasu M, Singh AK, LaguduvaH A. A Simple Adaptation for the Convenient Application of Incentive Spirometry in Tracheostomized Critically Ill Patients. Indian J Crit Care Med 2024;28(5):520–521.

Keywords

Incentive spirometry
Inspiratory muscle training
Tracheostomy
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pmc Dear Editor,

Inspiratory muscle training is vital in the recovery of critically ill patients to promote pulmonary expansion, airway clearance, and respiratory muscle strengthening, and incentive spirometry aids in achieving this.1 It is designed by the manufacturer with a mouthpiece adaptor at the patient end.1 In tracheostomized patients, spirometry use poses two challenges namely, attaching the device while allowing exhalation, and provision for oxygen therapy. The patient end adaptor of the spirometer has to be modified to connect it to the 15 mm universal connector of the tracheostomy tube. We designed a modification using the elbow connector of a breathing circuit and a catheter mount with a double-swivel port (Fig. 1). The flexible part of the catheter mount helps in 360-degree rotation of the spirometer according to patient comfort. The double swivel port has to be occluded with the finger of the respiratory therapist/patient during maximal inspiration and unblocked during expiration (Fig. 2).

Figs 1A to C Modified incentive spirometer assembly. (A) Incentive spirometer; (B) Elbow connector with gas sampling port (yellow arrow) for oxygen tubing connection; (C) Catheter mount with double-swivel port and flip-top cap (red arrow) for expiration

Figs 2A and B Technique of application during the respiratory cycle. (A) Occlusion of the double-swivel port during inspiration; (B) Venting of the double-swivel port during expiration

Oxygen can be supplemented by connecting oxygen tubing to the gas sampling port of the elbow connector (Fig. 1). The presence of hypoxia in critically ill patients limits the use of flow-oriented incentive spirometry devices without an oxygen supplementation port. The simple adaptation we suggested could aid in lung expansion therapy without interruption of oxygen therapy.

Malhotra et al.2 and Goldstein et al.3 have suggested the use of a Wye adaptor for the application of incentive spirometry in tracheostomized patients. Bloria et al. proposed the use of a modified endotracheal tube as an adapter.4 These modifications have been demonstrated to be safe in tracheostomized patients.2–4 We propose another simple, inexpensive adaptation of the incentive spirometer for application in tracheostomized patients. It can be easily made using the catheter mount and elbow connectors, which are ubiquitous in an intensive care unit. Adequate patient cooperation and understanding of the design modification are essential for effective use.

Orcid

Meenupriya Arasu https://orcid.org/0000-0002-2744-8716

Akhil Kant Singh https://orcid.org/0000-0002-6662-9819

Akshay LaguduvaH https://orcid.org/0009-0008-3172-5190

Source of support: Nil

Conflict of interest: None
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References

1. Restrepo RD Wettstein R Wittnebel L Tracy M Incentive spirometry Respir Care 2011 56 10 1600 1604 10.4187/respcare.01471 22008401
2. Malhotra N Malhotra P Verma D Incentive spirometry in tracheostomized patients J Anaesthesiol Clin Pharmacol 2007 23 1 77 78 Available from: https://scholar.google.com/scholar_lookup?journal=J+Anesth+Clin+Pharmacol&title=Incentive+spirometry+in+tracheostomized+patients&author=N+Malhotra&author=P+Malhotra&author=D+Verma&volume=23&publication_year=2007&pages=77-8&
3. Goldstein GH Iloreta AM Ojo B Malkin BD Incentive spirometry for the tracheostomy patient Otolaryngol Head Neck Surg 2012 147 6 1065 1068 10.1177/0194599812457649 22886076
4. Bloria SD Bloria P Luthra A Kataria K Using endotracheal tube as an adaptor to provide incentive spirometry to tracheostomised patients Indian J Anaesth 2019 63 10 872 873 10.4103/ija.IJA_371_19 31649408
