Postoperative outcomes following preoperative inspiratory muscle training in patients undergoing cardiothoracic or upper abdominal surgery: a systematic review and meta analysis

Mans, Christina; Reeve, Julie; Elkins, Mark R.

doi:10.1177/0269215514545350

Cited by 116 publications

(83 citation statements)

References 36 publications

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“…A recent systematic review also confirmed a 50% reduction in PCC in patients undergoing cardiothoracic and upper abdominal surgery who completed preoperative respiratory muscle training programs. It is thought that respiratory muscle weakness contributes to PCC [24]. …”

Section: Preoperative Lung Protective Strategiesmentioning

confidence: 99%

Perioperative lung protection

Marseu

Slinger

2017

Korean J Anesthesiol

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Perioperative pulmonary complications are known to be a major cause of morbidity and mortality, and as such, contribute a large burden to the health care system globally. Anesthesiologists have an important role during the perioperative period to identify patients at risk of these complications and intervene in order to reduce them. After describing perioperative pulmonary complications and risk factors for such, this article will address preoperative, intraoperative, and postoperative lung protective strategies to try and reduce the risk of these complications.

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Section: Preoperative Lung Protective Strategiesmentioning

confidence: 99%

Perioperative lung protection

Marseu

Slinger

2017

Korean J Anesthesiol

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“…Inspiratory muscle training (IMT), a training modality aimed at increasing strength and endurance of the inspiratory muscles, can increase ventilatory capacity. Systematic reviews of patients undergoing cardiac and upper abdominal surgery have shown that preoperative IMT can decrease the rate of postoperative pneumonia. Whether preoperative IMT is of benefit in patients undergoing oesophagectomy is unclear.…”

Section: Introductionmentioning

confidence: 99%

Multicentre randomized clinical trial of inspiratory muscle training versus usual care before surgery for oesophageal cancer

Valkenet

Trappenburg

Ruurda

et al. 2018

British Journal of Surgery

127

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Background Up to 40 per cent of patients undergoing oesophagectomy develop pneumonia. The aim of this study was to assess whether preoperative inspiratory muscle training (IMT) reduces the rate of pneumonia after oesophagectomy. Methods Patients with oesophageal cancer were randomized to a home‐based IMT programme before surgery or usual care. IMT included the use of a flow‐resistive inspiratory loading device, and patients were instructed to train twice a day at high intensity (more than 60 per cent of maximum inspiratory muscle strength) for 2 weeks or longer until surgery. The primary outcome was postoperative pneumonia; secondary outcomes were inspiratory muscle function, lung function, postoperative complications, duration of mechanical ventilation, length of hospital stay and physical functioning. Results Postoperative pneumonia was diagnosed in 47 (39·2 per cent) of 120 patients in the IMT group and in 43 (35·5 per cent) of 121 patients in the control group (relative risk 1·10, 95 per cent c.i. 0·79 to 1·53; P = 0·561). There was no statistically significant difference in postoperative outcomes between the groups. Mean(s.d.) maximal inspiratory muscle strength increased from 76·2(26·4) to 89·0(29·4) cmH2O (P < 0·001) in the intervention group and from 74·0(30·2) to 80·0(30·1) cmH2O in the control group (P < 0·001). Preoperative inspiratory muscle endurance increased from 4 min 14 s to 7 min 17 s in the intervention group (P < 0·001) and from 4 min 20 s to 5 min 5 s in the control group (P = 0·007). The increases were highest in the intervention group (P < 0·050). Conclusion Despite an increase in preoperative inspiratory muscle function, home‐based preoperative IMT did not lead to a decreased rate of pneumonia after oesophagectomy. Registration number: NCT01893008 (https://www.clinicaltrials.gov).

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“…2 Risk factors for PPCs are: duration of anaesthesia, surgical category, current smoking, respiratory comorbidity, and predicted maximal oxygen uptake. 3 Preoperative physiotherapy interventions, 4 particularly inspiratory muscle training, 5 decrease the risk of PPCs. Postoperatively, early mobilisation is recommended to minimise PPCs.…”

Section: Introductionmentioning

confidence: 99%