Research progress on preoperative inspiratory muscle training for prevention of postoperative pulmonary complications in adult cardiac surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LUO Zeruxin ¹ , WANG Yuqiang ² , ZHOU Yaxin ¹ , GUO Yingqiang ² ,  YU Pengming ^1,3

1. Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
2. Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
3. Key Laboratory of Rehabilitation Medicine of Sichuan Province, Chengdu, 610041, P. R. China;

Corresponding author：

YU Pengming, Email: 13438201451@126.com

Keywords：

Cardiac surgery; postoperative pulmonary complications; inspiratory muscle training; pre-rehabilitation; enhanced recovery after surgery; review

DOI：

10.7507/1007-4848.202202053

Video：

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In the past two decades, adult cardiac surgery has developed by leaps and bounds in both anesthetic techniques and surgical methods, whereas the incidence of postoperative pulmonary complications (PPCs) has not changed. Until now PPCs are still the most common complications after cardiac surgery, resulting in poor prognosis, significantly prolonged hospital stays and increased medical costs. With the promotion of the concept of enhanced recovery after surgery (ERAS), pre-rehabilitation has been becoming a basic therapy to prevent postoperative complications. Among them, preoperative inspiratory muscle training as a very potential intervention method has been widely and deeply studied. However, there is still no consensus about the definition and diagnostic criteria of PPCs around the world; and there is significant heterogeneity in preoperative inspiratory muscle training in the prevention of pulmonary complications after cardiac surgery in adults, which impedes its clinical application. This paper reviewed the definition, mechanism, and evaluation tools of PPCs, as well as the role, implementation plan and challenges of preoperative inspiratory muscle training in the prevention of PPCs in patients undergoing cardiac surgery, to provide reference for clinical application.

Citation： LUO Zeruxin, WANG Yuqiang, ZHOU Yaxin, GUO Yingqiang, YU Pengming. Research progress on preoperative inspiratory muscle training for prevention of postoperative pulmonary complications in adult cardiac surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(10): 1519-1523. doi: 10.7507/1007-4848.202202053 Copy

1.	Jeong BH, Shin B, Eom JS, et al. Development of a prediction rule for estimating postoperative pulmonary complications. PLoS One, 2014, 9(12): e113656.
2.	Badenes R, Lozano A, Belda FJ. Postoperative pulmonary dysfunction and mechanical ventilation in cardiac surgery. Crit Care Res Pract, 2015, 2015: 420513.
3.	Karanfil EOT, Møller AM. Preoperative inspiratory muscle training prevents pulmonary complications after cardiac surgery: A systematic review. Dan Med J, 2018, 65(3): A5450.
4.	Tanner TG, Colvin MO. Pulmonary complications of cardiac surgery. Lung, 2020, 198(6): 889-896.
5.	Apostolakis E, Filos KS, Koletsis E, et al. Lung dysfunction following cardiopulmonary bypass. J Card Surg, 2010, 25(1): 47-55.
6.	Jammer I, Wickboldt N, Sander M, et al. Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions: A statement from the ESA-ESICM Joint Taskforce on Perioperative Outcome Measures. Eur J Anaesthesiol, 2015, 32(2): 88-105.
7.	Varela G, Ballesteros E, Jiménez MF, et al. Cost-effectiveness analysis of prophylactic respiratory physiotherapy in pulmonary lobectomy. Eur J Cardiothorac Surg, 2006, 29(2): 216-220.
8.	Renault JA, Costa-Val R, Rossetti MB. Respiratory physiotherapy in the pulmonary dysfunction after cardiac surgery. Rev Bras Cir Cardiovasc, 2008, 23(4): 562-569.
9.	Brooks-Brunn JA. Predictors of postoperative pulmonary complications following abdominal surgery. Chest, 1997, 111(3): 564-571.
10.	Gosselink R, Schrever K, Cops P, et al. Incentive spirometry does not enhance recovery after thoracic surgery. Crit Care Med, 2000, 28(3): 679-683.
11.	Reeve JC, Nicol K, Stiller K, et al. Does physiotherapy reduce the incidence of postoperative pulmonary complications following pulmonary resection via open thoracotomy? A preliminary randomized single-blind clinical trial. Eur J Cardiothorac Surg, 2010, 37(5): 1158-1166.
12.	Agostini P, Naidu B, Cieslik H, et al. Comparison of recognition tools for postoperative pulmonary complications following thoracotomy. Physiotherapy, 2011, 97(4): 278-283.
13.	Sameed M, Choi H, Auron M, et al. Preoperative pulmonary risk assessment. Respir Care, 2021, 66(7): 1150-1166.
14.	Ellenberger C, Schorer R, Bedat B, et al. How can we minimize the risks by optimizing patient's condition shortly before thoracic surgery? Saudi J Anaesth, 2021, 15(3): 264-271.
15.	Smetana GW. Postoperative pulmonary complications: An update on risk assessment and reduction. Cleve Clin J Med, 2009, 76 Suppl 4: S60-S65.
16.	Winkelmann ER, Steffens É, Windmöller P, et al. Preoperative expiratory and inspiratory muscle weakness to predict postoperative outcomes in patients undergoing elective cardiac surgery. J Card Surg, 2020, 35(1): 128-134.
17.	Ge X, Wang W, Hou L, et al. Inspiratory muscle training is associated with decreased postoperative pulmonary complications: Evidence from randomized trials. J Thorac Cardiovasc Surg, 2018, 156(3): 1290-1300.
18.	Cavayas YA, Eljaiek R, Rodrigue É, et al. Preoperative diaphragm function is associated with postoperative pulmonary complications after cardiac surgery. Crit Care Med, 2019, 47(12): e966-e974.
19.	D'Arx A, Freene N, Bowen S, et al. What is the prevalence of inspiratory muscle weakness in preoperative cardiac surgery patients? An observational study. Heart Lung, 2020, 49(6): 909-914.
20.	Efthimiou J, Butler J, Woodham C, et al. Diaphragm paralysis following cardiac surgery: Role of phrenic nerve cold injury. Ann Thorac Surg, 1991, 52(4): 1005-1008.
21.	Christopher N. Postoperative pulmonary complications of cardiac surgery. Chest, 2021: 40-41.
22.	Islam M, Levitus M, Eisen L, et al. Lung ultrasound for the diagnosis and management of acute respiratory failure. Lung, 2020, 198(1): 1-11.
23.	Miskovic A, Lumb AB. Postoperative pulmonary complications. Br J Anaesth, 2017, 118(3): 317-334.
24.	Faghy M. A review of Inspiratory muscle training. When and why does it work?. Jpn J Phys Fit Sports Med, 2019, 68(1): 3-5.
25.	Bausek N, Berlin T, Aldarondo S. The power and potential of respiratory muscle training. Respir Equipm Devic Exhibit Magaz, 2016: 86-96.
26.	de Oliveira Borja R, Fernandes Campos T, Tereza Santiago De Oliveira K, et al. Protocol for preoperative inspiratory muscle training in elective cardiac surgery: Pilot study. Conscient Saúde, 2012, 11(2): 1-6.
27.	Weiner P, Zeidan F, Zamir D, et al. Prophylactic inspiratory muscle training in patients undergoing coronary artery bypass graft. World J Surg, 1998, 22(5): 427-431.
28.	Kendall F, Oliveira J, Peleteiro B, et al. Inspiratory muscle training is effective to reduce postoperative pulmonary complications and length of hospital stay: A systematic review and meta-analysis. Disabil Rehabil, 2018, 40(8): 864-882.
29.	Bissett B, Leditschke IA, Green M, et al. Inspiratory muscle training for intensive care patients: A multidisciplinary practical guide for clinicians. Aust Crit Care, 2019, 32(3): 249-255.
30.	Cipriano GF, Cipriano G, Santos FV, et al. Current insights of inspiratory muscle training on the cardiovascular system: A systematic review with meta-analysis. Integr Blood Press Control, 2019, 12: 1-11.
31.	Arutyunov GP, Kolesnikova EA, Ilyina KV, et al. New approaches for the respiratory muscle trainings based on morphological features of the diaphragm. Eur J Heart Fail, 2019, 21: 341.
32.	Chen X, Hou L, Zhang Y, et al. 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. Clin Rehabil, 2019, 33(5): 913-922.
33.	Katsura M, Kuriyama A, Takeshima T, et al. Preoperative inspiratory muscle training for postoperative pulmonary complications in adults undergoing cardiac and major abdominal surgery. Cochrane Database Syst Rev, 2015, 10: CD010356.
34.	Cordeiro AL, de Melo TA, Neves D, et al. Inspiratory muscle training and functional capacity in patients undergoing cardiac surgery. Braz J Cardiovasc Surg, 2016, 31(2): 140-144.
35.	Valkenet K, de Heer F, Backx FJ, et al. Effect of inspiratory muscle training before cardiac surgery in routine care. Phys Ther, 2013, 93(5): 611-619.
36.	Robinson TN, Carli F, Scheede-Bergdahl C. In: Feldman L, Delaney C, Ljungqvist O, et al. (eds) The SAGES / ERAS® Society Manual of Enhanced Recovery Programs for Gastrointestinal Surgery. Springer, Cham, 2015. 25-39.
37.	Chou CH, Chen CY. Inspiratory muscle training for reducing postoperative pulmonary complications: A simple method that we hope is effective. J Thorac Cardiovasc Surg, 2018, 156(3): 1301-1302.
38.	Riedi C, Mora CT, Driessen T, et al. Relation between respiratory muscle strength with respiratory complication on the heart surgery. Rev Bras Cir Cardiovasc, 2010, 25(4): 500-505.
39.	Morsch KT, Leguisamo CP, Camargo MD, et al. Perfil ventilatório dos pacientes submetidos a cirurgia de revascularização do miocárdio. Braz J Cardiovasc Surg, 2009, 24: 180-187.
40.	Yánez-Brage I, Pita-Fernández S, Juffé-Stein A, 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.
41.	Hulzebos EH, Helders PJ, Favié NJ, 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.

1. Jeong BH, Shin B, Eom JS, et al. Development of a prediction rule for estimating postoperative pulmonary complications. PLoS One, 2014, 9(12): e113656.
2. Badenes R, Lozano A, Belda FJ. Postoperative pulmonary dysfunction and mechanical ventilation in cardiac surgery. Crit Care Res Pract, 2015, 2015: 420513.
3. Karanfil EOT, Møller AM. Preoperative inspiratory muscle training prevents pulmonary complications after cardiac surgery: A systematic review. Dan Med J, 2018, 65(3): A5450.
4. Tanner TG, Colvin MO. Pulmonary complications of cardiac surgery. Lung, 2020, 198(6): 889-896.
5. Apostolakis E, Filos KS, Koletsis E, et al. Lung dysfunction following cardiopulmonary bypass. J Card Surg, 2010, 25(1): 47-55.
6. Jammer I, Wickboldt N, Sander M, et al. Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions: A statement from the ESA-ESICM Joint Taskforce on Perioperative Outcome Measures. Eur J Anaesthesiol, 2015, 32(2): 88-105.
7. Varela G, Ballesteros E, Jiménez MF, et al. Cost-effectiveness analysis of prophylactic respiratory physiotherapy in pulmonary lobectomy. Eur J Cardiothorac Surg, 2006, 29(2): 216-220.
8. Renault JA, Costa-Val R, Rossetti MB. Respiratory physiotherapy in the pulmonary dysfunction after cardiac surgery. Rev Bras Cir Cardiovasc, 2008, 23(4): 562-569.
9. Brooks-Brunn JA. Predictors of postoperative pulmonary complications following abdominal surgery. Chest, 1997, 111(3): 564-571.
10. Gosselink R, Schrever K, Cops P, et al. Incentive spirometry does not enhance recovery after thoracic surgery. Crit Care Med, 2000, 28(3): 679-683.
11. Reeve JC, Nicol K, Stiller K, et al. Does physiotherapy reduce the incidence of postoperative pulmonary complications following pulmonary resection via open thoracotomy? A preliminary randomized single-blind clinical trial. Eur J Cardiothorac Surg, 2010, 37(5): 1158-1166.
12. Agostini P, Naidu B, Cieslik H, et al. Comparison of recognition tools for postoperative pulmonary complications following thoracotomy. Physiotherapy, 2011, 97(4): 278-283.
13. Sameed M, Choi H, Auron M, et al. Preoperative pulmonary risk assessment. Respir Care, 2021, 66(7): 1150-1166.
14. Ellenberger C, Schorer R, Bedat B, et al. How can we minimize the risks by optimizing patient's condition shortly before thoracic surgery? Saudi J Anaesth, 2021, 15(3): 264-271.
15. Smetana GW. Postoperative pulmonary complications: An update on risk assessment and reduction. Cleve Clin J Med, 2009, 76 Suppl 4: S60-S65.
16. Winkelmann ER, Steffens É, Windmöller P, et al. Preoperative expiratory and inspiratory muscle weakness to predict postoperative outcomes in patients undergoing elective cardiac surgery. J Card Surg, 2020, 35(1): 128-134.
17. Ge X, Wang W, Hou L, et al. Inspiratory muscle training is associated with decreased postoperative pulmonary complications: Evidence from randomized trials. J Thorac Cardiovasc Surg, 2018, 156(3): 1290-1300.
18. Cavayas YA, Eljaiek R, Rodrigue É, et al. Preoperative diaphragm function is associated with postoperative pulmonary complications after cardiac surgery. Crit Care Med, 2019, 47(12): e966-e974.
19. D'Arx A, Freene N, Bowen S, et al. What is the prevalence of inspiratory muscle weakness in preoperative cardiac surgery patients? An observational study. Heart Lung, 2020, 49(6): 909-914.
20. Efthimiou J, Butler J, Woodham C, et al. Diaphragm paralysis following cardiac surgery: Role of phrenic nerve cold injury. Ann Thorac Surg, 1991, 52(4): 1005-1008.
21. Christopher N. Postoperative pulmonary complications of cardiac surgery. Chest, 2021: 40-41.
22. Islam M, Levitus M, Eisen L, et al. Lung ultrasound for the diagnosis and management of acute respiratory failure. Lung, 2020, 198(1): 1-11.
23. Miskovic A, Lumb AB. Postoperative pulmonary complications. Br J Anaesth, 2017, 118(3): 317-334.
24. Faghy M. A review of Inspiratory muscle training. When and why does it work?. Jpn J Phys Fit Sports Med, 2019, 68(1): 3-5.
25. Bausek N, Berlin T, Aldarondo S. The power and potential of respiratory muscle training. Respir Equipm Devic Exhibit Magaz, 2016: 86-96.
26. de Oliveira Borja R, Fernandes Campos T, Tereza Santiago De Oliveira K, et al. Protocol for preoperative inspiratory muscle training in elective cardiac surgery: Pilot study. Conscient Saúde, 2012, 11(2): 1-6.
27. Weiner P, Zeidan F, Zamir D, et al. Prophylactic inspiratory muscle training in patients undergoing coronary artery bypass graft. World J Surg, 1998, 22(5): 427-431.
28. Kendall F, Oliveira J, Peleteiro B, et al. Inspiratory muscle training is effective to reduce postoperative pulmonary complications and length of hospital stay: A systematic review and meta-analysis. Disabil Rehabil, 2018, 40(8): 864-882.
29. Bissett B, Leditschke IA, Green M, et al. Inspiratory muscle training for intensive care patients: A multidisciplinary practical guide for clinicians. Aust Crit Care, 2019, 32(3): 249-255.
30. Cipriano GF, Cipriano G, Santos FV, et al. Current insights of inspiratory muscle training on the cardiovascular system: A systematic review with meta-analysis. Integr Blood Press Control, 2019, 12: 1-11.
31. Arutyunov GP, Kolesnikova EA, Ilyina KV, et al. New approaches for the respiratory muscle trainings based on morphological features of the diaphragm. Eur J Heart Fail, 2019, 21: 341.
32. Chen X, Hou L, Zhang Y, et al. 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. Clin Rehabil, 2019, 33(5): 913-922.
33. Katsura M, Kuriyama A, Takeshima T, et al. Preoperative inspiratory muscle training for postoperative pulmonary complications in adults undergoing cardiac and major abdominal surgery. Cochrane Database Syst Rev, 2015, 10: CD010356.
34. Cordeiro AL, de Melo TA, Neves D, et al. Inspiratory muscle training and functional capacity in patients undergoing cardiac surgery. Braz J Cardiovasc Surg, 2016, 31(2): 140-144.
35. Valkenet K, de Heer F, Backx FJ, et al. Effect of inspiratory muscle training before cardiac surgery in routine care. Phys Ther, 2013, 93(5): 611-619.
36. Robinson TN, Carli F, Scheede-Bergdahl C. In: Feldman L, Delaney C, Ljungqvist O, et al. (eds) The SAGES / ERAS® Society Manual of Enhanced Recovery Programs for Gastrointestinal Surgery. Springer, Cham, 2015. 25-39.
37. Chou CH, Chen CY. Inspiratory muscle training for reducing postoperative pulmonary complications: A simple method that we hope is effective. J Thorac Cardiovasc Surg, 2018, 156(3): 1301-1302.
38. Riedi C, Mora CT, Driessen T, et al. Relation between respiratory muscle strength with respiratory complication on the heart surgery. Rev Bras Cir Cardiovasc, 2010, 25(4): 500-505.
39. Morsch KT, Leguisamo CP, Camargo MD, et al. Perfil ventilatório dos pacientes submetidos a cirurgia de revascularização do miocárdio. Braz J Cardiovasc Surg, 2009, 24: 180-187.
40. Yánez-Brage I, Pita-Fernández S, Juffé-Stein A, 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.
41. Hulzebos EH, Helders PJ, Favié NJ, 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.

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Research progress on preoperative inspiratory muscle training for prevention of postoperative pulmonary complications in adult cardiac surgery

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