Incentive spirometry is a common respiratory therapy tool, while pulmonary embolism (PE) is a life-threatening medical emergency involving the cardiovascular system. Although acute PE is not universally listed as an absolute contraindication for this device, its use is widely considered inappropriate and potentially detrimental during the initial, unstable phase of the illness. The clinical focus on a patient suffering from PE must be on immediate stabilization and resolving the underlying clot, not on respiratory exercises.
How Incentive Spirometry Works and Its Standard Use
Incentive spirometry is a handheld medical device designed to encourage patients to take slow, deep breaths to maximize lung inflation. The device provides visual feedback, often through a rising piston or balls, which helps the patient measure the volume of air inhaled. The goal is to train the patient to achieve and sustain a maximal, deep inhalation, which helps ensure that the deepest portions of the lungs are fully expanded.
This therapy is a standard preventative measure used primarily to avoid pulmonary complications, particularly after abdominal or chest surgery. When a patient is recovering from surgery or prolonged illness, their breathing often becomes shallow, which can lead to a condition called atelectasis, or partial lung collapse. By encouraging deep breaths, the incentive spirometer helps to keep the small air sacs (alveoli) open, preventing fluid build-up and reducing the risk of pneumonia.
The device works best when the patient is stable enough to cooperate and perform the exercises effectively. Its function is fundamentally mechanical, focusing on reversing the effects of shallow breathing and expanding lung volume. Therefore, it is a tool for pulmonary hygiene and prevention, not an intervention for an acute, life-threatening vascular crisis.
The Nature of Pulmonary Embolism
Pulmonary embolism is a serious, acute condition that occurs when a blood clot, usually originating from a deep vein in the legs, travels and lodges in one of the pulmonary arteries in the lungs. This blockage severely restricts blood flow to a portion of the lung tissue, immediately compromising the body’s ability to exchange oxygen and carbon dioxide. The mechanical obstruction causes an abrupt increase in pressure within the pulmonary arteries.
This sudden rise in pressure places significant strain on the right side of the heart, which is responsible for pumping blood through the lungs. In severe cases, the right ventricle can fail due to this pressure overload, leading to systemic hypotension, shock, and potentially cardiac arrest. Because of this pathophysiology, PE is a medical emergency that demands rapid intervention to restore blood flow and prevent right heart failure.
Is Incentive Spirometry Contraindicated
The deep, forced inspiration required for the device is typically impossible for a patient in acute respiratory distress from a PE, as they are often too unstable, hypoxic, or experiencing severe pleuritic chest pain. The primary issue is that the maneuvers might introduce unnecessary physiological stress to an already compromised cardiorespiratory system.
Aggressive deep breathing, especially when forced, can increase intrathoracic pressure. For a patient with a PE, whose right ventricle is already struggling against high pressure in the pulmonary arteries, this increased pressure could potentially worsen right ventricular dysfunction and compromise blood return to the heart. Focusing on this lung-expansion exercise also distracts from the immediate, life-saving priorities of managing the cardiovascular crisis. Some evidence even suggests that the exertion of deep breathing exercises could theoretically dislodge existing clots or further strain the pulmonary vasculature, although this remains a theoretical concern.
Prioritized Treatment for Pulmonary Embolism
The immediate steps involve supportive care, such as administering supplemental oxygen to counteract the low oxygen levels resulting from the blocked blood flow. The cornerstone of therapy for nearly all PE cases is immediate anticoagulation, or the use of blood thinners.
Anticoagulants, such as heparin or low-molecular-weight heparin, do not dissolve the existing clot but prevent it from growing larger and stop new clots from forming. In patients experiencing hemodynamic instability or shock, more aggressive reperfusion strategies are necessary. These may include systemic thrombolysis, which uses “clot-busting” drugs to rapidly dissolve the obstruction, or surgical embolectomy to physically remove the clot. These urgent, life-saving measures take clear precedence over any elective respiratory therapy like incentive spirometry.