Effect of preoperative inspiratory muscle training on postoperative outcomes in patients undergoing cardiac surgery:A systematic review and meta-analysis

BACKGROUND Cardiovascular disease is the most prevalent disease worldwide and places a great burden on the health and economic welfare of patients.Cardiac surgery is an important way to treat cardiovascular disease,but it can prolong mechanical ventilation time,intensive care unit(ICU)stay,and postoperative hospitalization for patients.Previous studies have demonstrated that preoperative inspiratory muscle training could decrease the incidence of postoperative pulmonary complications.AIM To explore the effect of preoperative inspiratory muscle training on mechanical ventilation time,length of ICU stay,and duration of postoperative hospitalization after cardiac surgery.METHODS A literature search of PubMed,Web of Science,Cochrane Library,EMBASE,China National Knowledge Infrastructure,WanFang,and the China Science and Technology journal VIP database was performed on April 13,2022.The data was independently extracted by two authors.The inclusion criteria were:(1)Randomized controlled trial;(2)Accessible as a full paper;(3)Patients who received cardiac surgery;(4)Preoperative inspiratory muscle training was implemented in these patients;(5)The study reported at least one of the following:Mechanical ventilation time,length of ICU stay,and/or duration of postoperative hospitalization;and(6)In English language.RESULTS We analyzed six randomized controlled trials with a total of 925 participants.The pooled mean difference of mechanical ventilation time was-0.45 h[95%confidence interval(CI):-1.59-0.69],which was not statistically significant between the intervention group and the control group.The pooled mean difference of length of ICU stay was 0.44 h(95%CI:-0.58-1.45).The pooled mean difference of postoperative hospitalization was-1.77 d in the intervention group vs the control group[95%CI:-2.41-(-1.12)].CONCLUSION Preoperative inspiratory muscle training may decrease the duration of postoperative hospitalization for patients undergoing cardiac surgery.More high-quality studies are needed to confirm our conclusion.

Reduction in pulmonary complications in high risk patients undergoing surgery for total hip replacement under general anesthesia by preoperative intensive inspiratory muscle training:A randomized controlled clinical trial

Objective： To evaluate the effects of preoperative inspiratory muscle training （IMT） on the incidence of atelectasis in patients at high risk of postoperative pulmonary complications scheduled for elective total hip replacement surgery under general anesthesia. Methods： Thirty two high-risk patients undergoing elective total hip replacement surgery under general anesthesia were chosen from Nanjing Medical University, Affiliated Nanjing First Hospital. In this single-blind randomized controlled clinical triM, patients were randomly assigned to receive preoperative inspiratory muscle training or conventional treatment （CT）. The major effectiveness outcome variables were atelectasis and duration of postoperative hospitalization. Results： Both groups were comparable prior to surgery. Seven patients in the CT group and 3 in the IMT group developed atelectasis （P = 0.25）. Median duration of postoperative hospitalization was 13 days （range, 10～17 days） in the IMT group versus 16 days （range, 11～23 days） in the CT group （Mann- Whitney U statistics, Z = -2.22, P = 0.03）. Mean postoperative inspiratory pressure was 5% higher in the IMT group. Conclusion： Preoperative intensive inspiratory muscle training appears to reduce the incidence of atelectasis and duration of postoperative hospitalization in patients at high risk of developing postoperative pulmonary complications who were scheduled for elective total hip replacement surgery under general anesthesia.

Test of incremental respiratory endurance as home-based, standalone therapy in chronic obstructive pulmonary disease: A case report

BACKGROUND The prevalence of chronic obstructive pulmonary disease(COPD)is increasing worldwide,and at the same time it is associated with increased mortality and reduced quality of life.Efforts to build sustainable rehabilitation approaches to COPD treatment and prevention are crucial.The system of long-term pulmonary rehabilitation care is insufficient.The main reasons for the absence of these outpatient programs are the lack of experience,the lack of interest of insurance companies in secondary prevention programs,and the lack of healthcare facilities in large geographical areas.The possibility of at-home pulmonary rehabilitation models(telemonitoring and telecoaching)could solve this problem.CASE SUMMARY A 71-year-old man with severe COPD,Global Initiative for Obstructive Lung Diseases stage 3 underwent an 8-wk remotely monitored inspiratory muscle training with a device based on the test of incremental respiratory endurance method.Spirometry,body plethysmography,test of incremental respiratory endurance examination,6-min walking test,body mass index,airflow obstruction,dyspnea,exercise capacity index,and subjective perception of dyspnea were performed as part of the initial and final examination.The patient performed training at home,and the physiotherapist monitored the patient remotely through a web application that allowed the physiotherapist to evaluate all training parameters in real-time and respond to any problems.After 8 wk of home training,there was a significant increase in all monitored values:maximal inspiratory pressure,a novel parameter sustained maximal inspiratory pressure,forced expiratory volume in 1 s,total lung capacity,forced vital capacity,peak expiratory flow,and inspiratory capacity.There was also an improvement in the perception of dyspnea according to the COPD Assessment Test and a modified Medical Research Council Breathlessness Scale,an increase in exercise tolerance according to the 6-min walking test,and a decrease in the exercise capacity index as a predictor of prognosis.CONCLUSION Respiratory telerehabilitation was greatly beneficial in a cooperative patient with COPD and may represent an alternative therapeutic approach to the increasing incidence of all lung diseases.

Addition of respiratory exercises to conventional rehabilitation for children and adolescents with cerebral palsy:a systematic review and meta-analysis

Background Respiratory dysfunctions are an important cause of morbidity and death in cerebral palsy(CP)populations.Respiratory exercises in addition to conventional rehabilitation have been suggested to improve respiratory status in CP patients.The objective of this systematic review and meta-analysis was to verify the effects of the addition of respiratory exercises to conventional rehabilitation on pulmonary function,functional capacity,respiratory muscle strength,gross motor function and quality of life in children and adolescents with CP.Methods We searched for randomized controlled clinical trials in PubMed/Medline,Lilacs,SciELO,EMBASE and Physi-otheraphy Evidence(PEDro)from their inception until July 2022 without language restrictions.Studies that included respiratory exercises(breathing exercise program;feedback respiratory training;incentive spirometer exercise;inspiratory muscle training;and combination of respiratory exercises+incentive spirometer exercise)in combination with conventional rehabilitation for children and adolescents with CP were evaluated by two independent reviewers.The mean difference(MD)and 95%confidence interval(CI)were estimated by random effect models.Results Ten studies met the eligibility criteria,including 324 children aged from 6 to 16 years.The meta-analysis showed an improvement in inspiratory muscle strength of 22.96 cmH2O(18.63-27.27,n=55)and pulmonary function of 0.60(0.38-0.82,n=98)for forced vital capacity(L);0.22(0.06-0.39,n=98)for forced expiratory volume at 1 second(L);and 0.50(0.05-0.04,n=98)for peak expiratory flow(L/min).Functional skills in daily living activities improved in the intervention group.Caregivers'assistance of daily living activities,functional capacity,gross motor function and expiratory muscle strength showed a nonsignificant improvement.Social well-being and acceptance and functioning domains improved in only one study.Conclusions Emerging data show significant enhancements in inspiratory muscle strength and pulmonary function in CP patients after respiratory training in addition to conventional rehabilitation.There is no consensus on the frequency,type or intensity of respiratory exercises for children with and adolescents with CP.