The effects of five days of intensive preoperative inspiratory muscle training on postoperative complications and outcome in patients having cardiac surgery: a randomized controlled trial

Abstract

Objective:

To determine the prophylactic efficacy of short-term intensive preoperative inspiratory muscle training on the incidence of postoperative pulmonary complications in patients scheduled for cardiac surgery.

Design:

Single-blind, randomized controlled pilot study.

Setting:

TEDA International Cardiovascular Hospital, China.

Subjects:

In total, 197 subjects aged ⩾50 years scheduled for cardiac surgery were selected.

Intervention:

The intervention group (n = 98) received five days of preoperative inspiratory muscle training on top of the usual care received by the patients in the control group (n = 99).

Main measures:

The primary outcome variable was the occurrence of postoperative pulmonary complications. The secondary outcome variables were inspiratory muscle strength, lung function and length of hospitalization.

Results:

After cardiac surgery, a total of 10 (10.2%) of the 98 patients in the intervention group and 27 (27.3%) of 99 patients in the control group had postoperative pulmonary complications (risk ratio, 0.23; 95% confidence interval (CI), 0.09–0.58, P = 0.002). The study revealed that, compared with the control group, the intervention group had a significant increase in inspiratory muscle strength (by 10.48 cm H₂O, P < 0.001), forced expiratory volume in the first second of expiration (FEV1) %predicted (by 3.75%, P = 0.030), forced vital capacity (FVC) %predicted (by 4.15%, P = 0.008) and maximal voluntary ventilation (MVV) %predicted (by 6.44%, P = 0.034). Length of hospital stay was 7.51 (2.83) days in the intervention group and 9.38 (3.10) days in the control group (P = 0.039).

Conclusion:

A five-day intensive pattern of preoperative inspiratory muscle training reduced the incidence of postoperative pulmonary complications and duration of postoperative hospitalization in patients undergoing cardiac surgery.

Keywords

Cardiac surgery inspiratory muscle training length of stay postoperative pulmonary complications

Get full access to this article

View all access options for this article.

References

Apostolakis

Filos

Koletsis

et al . Lung dysfunction following cardiopulmonary bypass. J Card Surg 2010; 25(1): 47–55.

Jensen

Yang

Risk factors for postoperative pulmonary complications in coronary artery bypass graft surgery patients. Eur J Cardiovasc Nurs 2007; 6(3): 241–246.

Laizo

Delgado

Rocha

GM.

Complications that increase the time of Hospitalization at ICU of patients submitted to cardiac surgery. Rev Bras Cir Cardiovasc 2010; 25(2): 166–171.

Stein

Maia

Silveira

et al . Inspiratory muscle strength as a determinant of functional capacity early after coronary artery bypass graft surgery. Arch Phys Med Rehabil 2009; 90(10): 1685–1691.

Gomes Neto

Martinez

Reis

et al . Pre- and postoperative inspiratory muscle training in patients undergoing cardiac surgery: systematic review and meta-analysis. Clin Rehabil 2017; 31(4): 454–464.

Snowdon

Haines

Skinner

EH.

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

Hulzebos

Helders

Favie

et al . 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.

Hulzebos

van Meeteren

van den Buijs

et al . 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.

Weiner

Zeidan

Zamir

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

10.

Yanez-Brage

Pita-Fernandez

Juffe-Stein

et al . Respiratory physiotherapy and incidence of pulmonary complications in off-pump coronary artery bypass graft surgery: an observational follow-up study. BMC Pulm Med 2009; 9: 36.

11.

Kroenke

Lawrence

Theroux

et al . Operative risk in patients with severe obstructive pulmonary disease. Arch Intern Med 1992; 152(5): 967–971.

12.

Chumillas

Ponce

Delgado

et al . Prevention of postoperative pulmonary complications through respiratory rehabilitation: a controlled clinical study. Arch Phys Med Rehabil 1998; 79(1): 5–9.

13.

Dal Nogare

. Nosocomial pneumonia in the medical and surgical patient. Risk factors and primary management. Med Clin North Am 1994; 78(5): 1081–1090.

14.

American Thoracic Society/European Respiratory Society. ATS/ERS Statement on Respiratory Muscle Testing. Am J Respir Crit Care Med 2002; 166(4): 518–624.

15.

Hedenstrom

Malmberg

Agarwal

Reference values for lung function tests in females. Regression equations with smoking variables. Bull Eur Physiopathol Respir 1985; 21(6): 551–557.

16.

Hedenstrom

Malmberg

Fridriksson

HV.

Reference values for lung function tests in men: regression equations with smoking variables. Ups J Med Sci 1986; 91(3): 299–310.

17.

Miller

Hankinson

Brusasco

et al . Standardisation of spirometry. Eur Respir J 2005; 26(2): 319–338.

18.

Borg

GA.

Psychophysical bases of perceived exertion. Med Sci Sports Exerc 1982; 14(5): 377–381.

19.

Siafakas

Mitrouska

Bouros

et al . Surgery and the respiratory muscles. Thorax 1999; 54(5): 458–465.

20.

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.

21.

Castillo

Haas

Chest physical therapy: comparative efficacy of preoperative and postoperative in the elderly. Arch Phys Med Rehabil 1985; 66(6): 376–379.

22.

Weiner

Suo

Fernandez

et al . Efficiency of the respiratory muscles in healthy individuals. Am Rev Respir Dis 1989; 140(2): 392–396.

23.

Eastwood

Hillman

Morton

et al . The effects of learning on the ventilatory responses to inspiratory threshold loading. Am J Respir Crit Care Med 1998; 158(4): 1190–1196.

24.

Komi

PV.

Training of muscle strength and power: interaction of neuromotoric, hypertrophic, and mechanical factors. Int J Sports Med 1986; 7(Suppl. 1): 10–15.

25.

Staron

Karapondo

Kraemer

et al . Skeletal muscle adaptations during early phase of heavy-resistance training in men and women. J Appl Physiol (1985) 1994; 76(3): 1247–1255.

26.

Ferreira

Rodrigues

Evora

PR.

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

27.

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.

28.

Shao

et al . 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.

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

0.13 MB