Hélène Laurent1,2,3, Sylvie Aubreton4, Géraud Galvaing5, Bruno Pereira6, Patrick Merle7, Ruddy Richard8,9,10, Frédéric Costes8,9,10, Marc Filaire8,9,5. 1. Clermont Auvergne University, Clermont-Ferrand, France - hlaurent@chu-clermontferrand.fr. 2. Unit of Human Nutrition, Research Nutrition Center, Clermont-Ferrand, France - hlaurent@chu-clermontferrand.fr. 3. Department of Physical Medicine and Rehabilitation, CHU Clermont-Ferrand, Clermont-Ferrand, France - hlaurent@chu-clermontferrand.fr. 4. Department of Physical Medicine and Rehabilitation, CHU Clermont-Ferrand, Clermont-Ferrand, France. 5. Department of Thoracic and Endocrinological Surgery, Center Jean Perrin, Clermont-Ferrand, France. 6. CHU Clermont-Ferrand, Délégation à la Recherche Clinique et à l'Innovation (DRCI), Clermont-Ferrand, France. 7. Department of Pneumology, CHU Clermont-Ferrand, Clermont-Ferrand, France. 8. Clermont Auvergne University, Clermont-Ferrand, France. 9. Unit of Human Nutrition, Research Nutrition Center, Clermont-Ferrand, France. 10. Department of Sports Medicine and Functional Explorations, CHU Clermont-Ferrand, Clermont-Ferrand, France.
Abstract
BACKGROUND:Resection surgery is the main treatment for non-small cell lung cancer (NSCLC). Postoperative complications and mortality are mostly linked to respiratory failure consecutive to respiratory muscle overload. AIM: We aimed to evaluate the effect of preoperative respiratory muscle endurance training (RMET) on respiratory muscle capacity and postoperative complications in patients undergoing NSCLC resection. DESIGN: Randomized controlled trial. SETTING:French university hospital. POPULATION: Patients eligible for NSCLC resection. METHODS: The training group (T group) performed a 3-week preoperative RMET added to usual chest physical therapy while the control group (C group) had only the latter. The primary outcome was the change in respiratory muscle endurance. Secondary outcomes were postoperative complications and mortality. Assessments were performed similarly at baseline and after the intervention. We conducted multivariable analyses with analysis of covariance (ANCOVA) taking into account baseline values for isocapnic hyperpnoea endurance test, exercise capacity and pulmonary function tests. The number of pulmonary postoperative complication was analyzed by Fisher-exact test. RESULTS: We included 26 patients with NSCLC (14 in the T group and 12 in the C group). Respiratory muscle endurance significantly increased in the T group after the RMET compared with C group (+229±199 vs. -5±371 sec, P=0.001). This increase was associated with a significantly lower number of pulmonary postoperative complications (2 vs. 10, P=0.037). CONCLUSIONS: Preoperative RMET improved respiratory muscle endurance and decreased pulmonary postoperative complications after surgery for NSCLC. These positive results obtained after RMET may help improve the perioperative course for such patients. These results should be confirmed in larger randomized controlled trials, including higher number of patients especially with altered respiratory muscle function. CLINICAL REHABILITATION IMPACT: Low-cost and easy to perform, RMET training could serve as complementary tool to usual chest physical therapy, before lung resection surgery.
RCT Entities:
BACKGROUND: Resection surgery is the main treatment for non-small cell lung cancer (NSCLC). Postoperative complications and mortality are mostly linked to respiratory failure consecutive to respiratory muscle overload. AIM: We aimed to evaluate the effect of preoperative respiratory muscle endurance training (RMET) on respiratory muscle capacity and postoperative complications in patients undergoing NSCLC resection. DESIGN: Randomized controlled trial. SETTING: French university hospital. POPULATION: Patients eligible for NSCLC resection. METHODS: The training group (T group) performed a 3-week preoperative RMET added to usual chest physical therapy while the control group (C group) had only the latter. The primary outcome was the change in respiratory muscle endurance. Secondary outcomes were postoperative complications and mortality. Assessments were performed similarly at baseline and after the intervention. We conducted multivariable analyses with analysis of covariance (ANCOVA) taking into account baseline values for isocapnic hyperpnoea endurance test, exercise capacity and pulmonary function tests. The number of pulmonary postoperative complication was analyzed by Fisher-exact test. RESULTS: We included 26 patients with NSCLC (14 in the T group and 12 in the C group). Respiratory muscle endurance significantly increased in the T group after the RMET compared with C group (+229±199 vs. -5±371 sec, P=0.001). This increase was associated with a significantly lower number of pulmonary postoperative complications (2 vs. 10, P=0.037). CONCLUSIONS: Preoperative RMET improved respiratory muscle endurance and decreased pulmonary postoperative complications after surgery for NSCLC. These positive results obtained after RMET may help improve the perioperative course for such patients. These results should be confirmed in larger randomized controlled trials, including higher number of patients especially with altered respiratory muscle function. CLINICAL REHABILITATION IMPACT: Low-cost and easy to perform, RMET training could serve as complementary tool to usual chest physical therapy, before lung resection surgery.
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