Filipa Kendall1,2,3, José Oliveira3, Bárbara Peleteiro4,5, Paulo Pinho1, Pedro Teixeira Bastos1. 1. a Department of Cardiothoracic Surgery , Centro Hospitalar de São João , Porto , Portugal. 2. b Polytechnic Health Institute of the North, CESPU, Gandra , Paredes , Portugal. 3. c Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport , University of Porto , Porto , Portugal. 4. d EPIUnit - Institute of Public Health , University of Porto , Porto , Portugal. 5. e Department of Clinical Epidemiology, Predictive Medicine and Public Health , Faculty of Medicine, University of Porto , Porto , Portugal.
Abstract
PURPOSE: This study systematically review and meta-analyse the effectiveness of inspiratory muscle training (IMT) to reduce postoperative pulmonary complications (PPC) and length of hospital stay (LOS), both in the preoperative and/or postoperative periods of cardiac, pulmonary, and abdominal surgical patients. Sensitive analysis was performed to examine which patients benefit more from IMT according to methodological features (quality of studies and sample size), patient's characteristics (pulmonary risk stratification, age, and body mass index), type of surgery, period of training, and training protocols (training doses and level of supervision). METHODS: The literature search was made in the electronic databases PubMed®, EBSCO, Web of Science®, PEDro and Scopus®. Only randomized controlled trials were included. Data extraction, quality assessment and meta-analysis were performed. RESULTS: We included 17 randomized controlled trials in the systematic review, of which, 12 were included for the PPC meta-analysis and 11 for the LOS meta-analysis. IMT significantly reduced the risk of PPC (Risk Ratio (RR) = 0.50, 95%CI: 0.39, 0.64, I2 = 0.0%), and a decrease in LOS (Mean Difference = -1.41, 95%CI: -2.07, -0.75, I2 = 0.0%). CONCLUSION: IMT is effective to reduce PPC and LOS in patients undergoing surgery. Implications for Rehabilitation Physiotherapy interventions with inspiratory muscle training (IMT) are effective to reduce postoperative pulmonary complications (PPC) and length of hospital stay (LOS) after major surgery, and should start preoperatively. Rehabilitation with IMT is beneficial at all ages and risk levels, but older and high-risk patients benefit more, as well as pulmonary surgery patients. IMT is more effective if it is supervised, and prescription target at least two-week period, sessions with more than 15 minutes, with imposed load increment, and adding other exercise modes.
PURPOSE: This study systematically review and meta-analyse the effectiveness of inspiratory muscle training (IMT) to reduce postoperative pulmonary complications (PPC) and length of hospital stay (LOS), both in the preoperative and/or postoperative periods of cardiac, pulmonary, and abdominal surgical patients. Sensitive analysis was performed to examine which patients benefit more from IMT according to methodological features (quality of studies and sample size), patient's characteristics (pulmonary risk stratification, age, and body mass index), type of surgery, period of training, and training protocols (training doses and level of supervision). METHODS: The literature search was made in the electronic databases PubMed®, EBSCO, Web of Science®, PEDro and Scopus®. Only randomized controlled trials were included. Data extraction, quality assessment and meta-analysis were performed. RESULTS: We included 17 randomized controlled trials in the systematic review, of which, 12 were included for the PPC meta-analysis and 11 for the LOS meta-analysis. IMT significantly reduced the risk of PPC (Risk Ratio (RR) = 0.50, 95%CI: 0.39, 0.64, I2 = 0.0%), and a decrease in LOS (Mean Difference = -1.41, 95%CI: -2.07, -0.75, I2 = 0.0%). CONCLUSION: IMT is effective to reduce PPC and LOS in patients undergoing surgery. Implications for Rehabilitation Physiotherapy interventions with inspiratory muscle training (IMT) are effective to reduce postoperative pulmonary complications (PPC) and length of hospital stay (LOS) after major surgery, and should start preoperatively. Rehabilitation with IMT is beneficial at all ages and risk levels, but older and high-risk patients benefit more, as well as pulmonary surgery patients. IMT is more effective if it is supervised, and prescription target at least two-week period, sessions with more than 15 minutes, with imposed load increment, and adding other exercise modes.
Authors: Carla Simonelli; Michele Vitacca; Nicolino Ambrosino; Simonetta Scalvini; Francesca Rivadossi; Manuela Saleri; Aubin G Fokom; Ilaria Speltoni; Riccardo Ghirardi; Mara Paneroni Journal: Int J Environ Res Public Health Date: 2020-02-05 Impact factor: 3.390
Authors: André Luiz Lisboa Cordeiro; Hayssa de Cássia Mascarenhas; Lucas Landerson; Jaclene da Silva Araújo; Daniel Lago Borges; Thiago Araújo de Melo; André Guimarães; Jefferson Petto Journal: Braz J Cardiovasc Surg Date: 2020-12-01