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What is sustained maximal inspiration (SMI)?
Maximal inspiratory effort
Held for ≥3 seconds
Also called incentive spirometry when performed with feedback device
What are indications for incentive spirometry?
↓ Intrathoracic lung volume
↓ Chest wall/lung compliance
V/Q mismatch
Atelectasis or risk of atelectasis
Thoracic/upper abdominal surgery
Restrictive lung defects
How is incentive spirometry performed?
Hold device vertically
Exhale completely
Seal lips around mouthpiece
Inhale slowly and deeply
Emphasize diaphragm/lower chest
Hold breath ≥3 seconds
How frequently should SMI be performed while awake?
5–10 breaths per hour
What are contraindications/precautions for incentive spirometry?
Unable/unwilling to cooperate
Unable to understand proper use
Unable to breathe deeply effectively
Vital capacity <10 mL/kg
Inspiratory capacity <⅓ predicted
Moderate-to-severe COPD with hyperinflation/increased RR
What are expected outcomes of incentive spirometry?
↓ Atelectasis
↓ Respiratory rate
Normal pulse rate
Improved chest X-ray
Improved PaO₂
↑ FVC
↑ Peak expiratory flow