Sage Journals: Discover world-class research

Abstract

Objective:

To determine the effects of pre- and postoperative inspiratory muscle training on length of postoperative hospital stay and pulmonary function in patients undergoing cardiac surgery.

Design and methods:

We conducted a systematic search using databases (MEDLINE, CINAHL, EMBASE, PEDro and the Cochrane) to find controlled trials evaluating the effects of pre- and postoperative inspiratory muscle training.

Results:

Eight studies fulfilled the inclusion criteria. Four were about preoperative inspiratory muscle training (416 patients), three about postoperative inspiratory muscle training (115 patients) and one study about pre- and postoperative inspiratory muscle training (43 patients). Preoperative inspiratory muscle training resulted in improvement in: Reduction in length of postoperative hospital stay of −2 days (95% CI −3.4, −0.7, N = 302), inspiratory pressure of 16.7 cm H₂O (95% CI 13.8, 19.5, N = 386), forced expiratory volume in one second of 3% predicted (95% CI 0.1, 6, N = 140), forced vital capacity of 4.6% predicted (95% CI 1.9, 7.4, N = 140). Patients that received preoperative training had an inspiratory muscle training reduced risk of postoperative pulmonary complications, (RR = 0.6; 95% CI 0.5 to 0.8; P = 0.0004, N = 386). Postoperative inspiratory muscle training resulted in improvement in inspiratory pressure of 16.5 cm H2O (95% CI 4.9, 27.8, N = 115), and tidal volume of 185 ml (95% CI 19.7, 349.8, N = 85).

Conclusion:

Pre- and postoperative inspiratory muscle training showed to be a beneficial intervention in the treatment of patients undergoing cardiac surgery.

Keywords

Cardiac surgery exercise respiratory muscle training preoperative care

Get full access to this article

View all access options for this article.

References

Rumsfeld

MaWhinney

McCarthy

Jr , et al. Health-related quality of life as a predictor of mortality following coronary artery bypass graft surgery. Participants of the Department of Veterans Affairs Cooperative Study Group on Processes, Structures, and Outcomes of Care in Cardiac Surgery. JAMA 1999; 281(14): 1298–1303.

Welsby

Nett-Guerrero

Atwell

, et al. The association of complication type with mortality and prolonged stay after cardiac surgery with cardiopulmonary bypass. Anesth Analg 2002; 94: 1072–1078.

Wynne

Botti

. Postoperative pulmonary dysfunction in adults after cardiac surgery with cardiopulmonary bypass: Clinical significance and implications for practice. Am J Crit Care 2004; 13(5): 384–393.

Valkenet

de Heer

Backx

, et al. Effect of inspiratory muscle training before cardiac surgery in routine care. Phys Ther 2013; 93: 611–619.

Westerdahl

Lindmark

Eriksson

Friberg

Hedenstierna

Tenling

. Deep-breathing exercises reduce atelectasis and improve pulmonary function after coronary artery bypass surgery. Chest 2005; 128: 3482–3488.

Herdy

Marcchi

Vila

, et al. Pre and postoperative cardiopulmonary rehabilitation in hospitalized patients undergoing coronary artery bypass surgery: A randomized controlled trial. Am J Phys Med Rehabil 2008; 87(9): 714–719.

Snowdon

Haines

Skinner

. Preoperative intervention reduces postoperative pulmonary complications but not length of stay in cardiac surgical patients: A systematic review. J Physiother 2014; 60(2): 66–77.

Valkenet

van de Port

IGL

Dronkers

de Vries

Lindeman

Backx

FJG

. The effects of preoperative exercise therapy on postoperative outcome: A systematic review. Clin Rehabil 2011; 25: 99–111.

Moher

Liberati

Tetzlaff

Altman

. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. BMJ 2009; 339: b2535.

10.

Higgins

JPT

Green

. Cochrane Handbook for Systematic Reviews of Interventions 4.2.6 [update September 2006]. Issue 4. Chichester: John Wiley & Sons, 2006.

11.

Olivo

Macedo

Gadotti

Fuentes

Stanton

Magee

. Scales to assess the quality of randomized controlled trials: A systematic review. Phys Ther 2008; 88(2): 156–175.

12.

Verhagen

de Vet

HCW

de Bie

, et al. The Delphi List: A criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi Consensus. J Clin Epidemiol 1998; 51(12): 1235–1241.

13.

Maher

Sherrington

Herbert

Moseley

Elkins

. Reliability of the PEDro scale for rating of quality randomized controlled trials. Phys Ther 2003; 83(8): 713–721.

14.

Higgins

Thompson

Deeks

Altman

. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557–560.

15.

Collaboration TC. Available at: www.cochrane.org (accessed 3 February 2008).

16.

Hulzebos

van Meeteren

van den Buijs

de Bie

Brutel de la Rivière

Helders

. Feasibility of preoperative inspiratory muscle training in patients undergoing coronary artery bypass surgery with a high risk of postoperative pulmonary complications: A randomized controlled pilot study. Clin Rehabil 2006; 20(11): 949–959.

17.

Hulzebos

Helders

PJM

Favié

De Bie

Brutel de la Riviere

Van Meeteren

. Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery: A randomized clinical trial. JAMA 2006; 296(15): 1851–1857.

18.

Weiner

Zeidan

Zamir

, et al. Prophylactic inspiratory muscle training in patients undergoing coronary artery bypass graft. World J Surg 1998; 22(5): 427–431.

19.

Ferreira

Rodrigues

Evora

. Effects of an inspiratory muscle rehabilitation program in the postoperative period of cardiac surgery. Arq Bras Cardiol 2009; 92(4): 275–282.

20.

Barros

Santos

Granado

Costa

Límaco

Gardenghi

. Respiratory muscle training in patients submitted to coronary arterial bypass graft. Rev Bras Cir Cardiovasc 2010; 25(4): 483–490.

21.

Matheus

Dragosavac

Trevisan

Costa

Lopes

Ribeiro

GCA

. Inspiratory muscle training improves tidal volume and vital capacity after CABG surgery. Rev Bras Cir Cardiovasc 2012; 27(3): 362–369.

22.

Praveen

Swaminathan

Praveen

. Inspiratory muscle training is effective in improving respiratory muscle functions in patients who have undergone coronary artery bypass graft. Fizjoterapia Polska [Polish J Physiother] 2009; 9(4): 285–292.

23.

Savci

Degirmenci

Saglam

, et al. Short-term effects of inspiratory muscle training in coronary artery bypass graft surgery: A randomized controlled trial. Scand Cardiovasc J 2011; 45(5): 286–293.

24.

Nomori

Kobayashi

Fuyuno

Morinaga

Yashima

. Preoperative respiratory muscle training. Assessment in thoracic surgery patients with special reference to postoperative pulmonary complications. Chest 1994; 105(6): 1782–1788.

25.

Canet

Mazo

. Postoperative pulmonary complications. Minerva Anestesiologica 2010; 76: 138–143.

26.

Shao

Lin

Xiang

. Prolonged postoperative length of stay is associated with poor overall survival after an esophagectomy for esophageal cancer. J Thorac Dis 2015; 7(11): 2018–2023.

27.

Cook

. Ventilator associated pneumonia: Perspectives on the burden of illness. Intensive Care Med 2000; 13: S031–S037.

28.

Jenkins

Soutar

Forsyth

Keates

Moxham

. Lung function after coronary artery surgery using the internal mammary artery and the saphenous vein. Thorax 1989; 44: 209–211.

29.

Berrizbeitia

Tessler

Jacobowitz

Kaplan

Budzilowicz

Cunningham

. Effect of sternotomy and coronary bypass surgery on postoperative pulmonary mechanics. Comparison of internal mammary and saphenous vein bypass grafts. Chest 1989; 96: 873–876.

30.

Litmathe

Kurt

Feindt

Gams

Boeken

. Predictors and outcome of ICU readmission after cardiac surgery. Thorac Cardiovasc Surg 2009; 57(7): 391–394.

31.

Joskowiak

Wilbring

Szlapka

, et al. Readmission to the intensive care unit after cardiac surgery: A single-center experience with 7105 patients. J Cardiovasc Surg (Torino) 2012; 53(5): 671–676.

32.

Kirby

Durbin

. Establishment of a respiratory assessment team is associated with decreased mortality in patients re-admitted to the ICU. Resp Care 1996; 41: 903–907.

33.

Vohra

Goldsmith

Rosin

Briffa

Patel

. The predictors and outcome of recidivism in cardiac ICUs. Eur J Cardiothorac Surg 2005; 27(3): 508–511.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.01 MB

0.30 MB

Pre- and postoperative inspiratory muscle training in patients undergoing cardiac surgery: systematic review and meta-analysis