Pre-operative inspiratory muscle training preserves postoperative inspiratory muscle strength following major abdominal surgery – a randomised pilot study

Kulkarni, SR; Fletcher, E. W. L.; McConnell, Alison; Poskitt, K. R.; Whyman,

doi:10.1308/003588410x12771863936648

Cited by 101 publications

(109 citation statements)

References 23 publications

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“…4,17,31 Preoperative breathing exercises may be useful in this high-risk population, although prior studies have shown mixed results. 6,19,32 Our data are consistent with much of the literature regarding the use of postoperative IS for prevention of PPCs. Lowrisk patients have shown mixed benefit of IS following abdominal or cardiac surgery in terms of recovery of pulmonary function, prevention of PPC, or reduction in length of hospital stay.…”

Section: Discussionsupporting

confidence: 88%

The Effect of Incentive Spirometry on Postoperative Pulmonary Function Following Laparotomy

Tyson¹,

Kendig

Mabedi

et al. 2015

JAMA Surg

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Section: Discussionsupporting

confidence: 88%

The Effect of Incentive Spirometry on Postoperative Pulmonary Function Following Laparotomy

Tyson¹,

Kendig

Mabedi

et al. 2015

JAMA Surg

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“…Preoperative inspiratory muscle strength training (IMST) has been shown to reduce the incidence of postoperative respiratory complications in high-risk cardiac surgery patients [14] and has also been demonstrated to preserve postoperative inspiratory muscle strength following major abdominal surgery [15]. …”

Section: Introductionmentioning

confidence: 99%

Inspiratory muscle strength training improves weaning outcome in failure to wean patients: a randomized trial

et al. 2011

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IntroductionMost patients are readily liberated from mechanical ventilation (MV) support, however, 10% - 15% of patients experience failure to wean (FTW). FTW patients account for approximately 40% of all MV days and have significantly worse clinical outcomes. MV induced inspiratory muscle weakness has been implicated as a contributor to FTW and recent work has documented inspiratory muscle weakness in humans supported with MV.MethodsWe conducted a single center, single-blind, randomized controlled trial to test whether inspiratory muscle strength training (IMST) would improve weaning outcome in FTW patients. Of 129 patients evaluated for participation, 69 were enrolled and studied. 35 subjects were randomly assigned to the IMST condition and 34 to the SHAM treatment. IMST was performed with a threshold inspiratory device, set at the highest pressure tolerated and progressed daily. SHAM training provided a constant, low inspiratory pressure load. Subjects completed 4 sets of 6-10 training breaths, 5 days per week. Subjects also performed progressively longer breathing trials daily per protocol. The weaning criterion was 72 consecutive hours without MV support. Subjects were blinded to group assignment, and were treated until weaned or 28 days.ResultsGroups were comparable on demographic and clinical variables at baseline. The IMST and SHAM groups respectively received 41.9 ± 25.5 vs. 47.3 ± 33.0 days of MV support prior to starting intervention, P = 0.36. The IMST and SHAM groups participated in 9.7 ± 4.0 and 11.0 ± 4.8 training sessions, respectively, P = 0.09. The SHAM group's pre to post-training maximal inspiratory pressure (MIP) change was not significant (-43.5 ± 17.8 vs. -45.1 ± 19.5 cm H2O, P = 0.39), while the IMST group's MIP increased (-44.4 ± 18.4 vs. -54.1 ± 17.8 cm H2O, P < 0.0001). There were no adverse events observed during IMST or SHAM treatments. Twenty-five of 35 IMST subjects weaned (71%, 95% confidence interval (CI) = 55% to 84%), while 16 of 34 (47%, 95% CI = 31% to 63%) SHAM subjects weaned, P = .039. The number of patients needed to be treated for effect was 4 (95% CI = 2 to 80).ConclusionsAn IMST program can lead to increased MIP and improved weaning outcome in FTW patients compared to SHAM treatment.Trial RegistrationClinicalTrials.gov: NCT00419458

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“…According to Smetana, preoperative IMT appears to be an important strategy in the prevention of PPC and has been used by some authors in thoracic, cardiac and abdominal surgeries 2,4,9,10. However, there are no studies that evaluate the effect of preoperative IMT in obese patients undergoing open bariatric surgery, and only one study has reported the effects of postoperative IMT 11…”

Section: Introductionmentioning

confidence: 99%

Effects of preoperative inspiratory muscle training in obese women undergoing open bariatric surgery: respiratory muscle strength, lung volumes, and diaphragmatic excursion

Barbalho-Moulim

Miguel

Pazzianotto-Forti

et al. 2011

Clinics

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OBJECTIVE:To determine whether preoperative inspiratory muscle training is able to attenuate the impact of surgical trauma on the respiratory muscle strength, in the lung volumes, and diaphragmatic excursion in obese women undergoing open bariatric surgery.DESIGN:Randomized controlled trial.SETTING:Meridional Hospital, Cariacica/ES, Brazil.SUBJECTS:Thirty-two obese women undergoing elective open bariatric surgery were randomly assigned to receive preoperative inspiratory muscle training (inspiratory muscle training group) or usual care (control group).MAIN MEASURES:Respiratory muscle strength (maximal static respiratory pressure – maximal inspiratory pressure and maximal expiratory pressure), lung volumes, and diaphragmatic excursion.RESULTS:After training, there was a significant increase only in the maximal inspiratory pressure in the inspiratory muscle training group. The maximal expiratory pressure, the lung volumes and the diaphragmatic excursion did not show any significant change with training. In the postoperative period there was a significant decrease in maximal inspiratory pressure in both the groups. However, there was a decrease of 28% in the inspiratory muscle training group, whereas it was 47% in the control group. The decrease in maximal expiratory pressure and in lung volumes in the postoperative period was similar between the groups. There was a significant reduction in the measures of diaphragmatic excursion in both the groups.CONCLUSION:The preoperative inspiratory muscle training increased the inspiratory muscle strength (maximal inspiratory pressure) and attenuated the negative postoperative effects of open bariatric surgery in obese women for this variable, though not influencing the lung volumes and the diaphragmatic excursion.

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Pre-operative inspiratory muscle training preserves postoperative inspiratory muscle strength following major abdominal surgery – a randomised pilot study

Abstract: Pre-operative specific IMT improves MIP pre-operatively and preserves it postoperatively. Further studies are required to establish if this is associated with reduced pulmonary complications.

Cited by 101 publications

References 23 publications

The Effect of Incentive Spirometry on Postoperative Pulmonary Function Following Laparotomy

The Effect of Incentive Spirometry on Postoperative Pulmonary Function Following Laparotomy

Inspiratory muscle strength training improves weaning outcome in failure to wean patients: a randomized trial

Effects of preoperative inspiratory muscle training in obese women undergoing open bariatric surgery: respiratory muscle strength, lung volumes, and diaphragmatic excursion

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