Preoperative inspiratory muscle training improves lung function prior to elective heart valve surgery and reduces postoperative lung function impairment and pulmonary complications: a randomised trial

IF 9.7 1区医学 Q1 ORTHOPEDICS Journal of Physiotherapy Pub Date : 2025-01-01 DOI:10.1016/j.jphys.2024.12.002

Pengming Yu , Zeruxin Luo , Yuqiang Wang , Song Lin , Deyu Qin , Alice YM Jones , Jiayuan He

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Abstract

Question

What is the effect of 3 days of preoperative inspiratory muscle training (IMT) on lung function prior to heart valve surgery and on postoperative lung function and pulmonary complications compared with sham and no IMT?

Design

A three-arm, multicentre, randomised controlled trial with concealed allocation, intention-to-treat analysis and blinded assessment of some outcomes.

Participants

This study included 228 adults scheduled for heart valve surgery.

Interventions

The IMT group received 3 days of IMT at 30% maximal inspiratory pressure, the sham IMT group received the same but at 10% maximal inspiratory pressure and the control group received no IMT.

Outcome measures

Spirometric measures, maximal inspiratory pressure and maximum voluntary ventilation were measured at hospital admission, the day before surgery and at discharge. The incidence of postoperative pulmonary complications (primary outcome) and adverse events were recorded.

Results

A total of 215 participants completed surgery as planned and all participants were followed up until discharge. Spirometric measures, maximal inspiratory pressure and maximum voluntary ventilation improved in all groups between admission and the day before surgery, but more so in the IMT group. At discharge, these measures had deteriorated in all groups, but less so in the IMT group. Preoperative IMT reduced the total number of participants experiencing a pulmonary complication in the IMT group compared with the sham IMT group (ARR –0.18, 95% CI –0.33 to –0.03) and compared with the control group (ARR –0.21, 95% CI –0.35 to –0.05). Very few adverse events occurred in all three groups.

Conclusions

Preoperative IMT improved lung function prior to surgery and at hospital discharge and reduced postoperative pulmonary complications in adults undergoing elective heart valve surgery.

Registration

ChiCTR2100054869.

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术前吸气肌训练可改善择期心脏瓣膜手术前的肺功能，并减少术后肺功能损伤和肺部并发症：一项随机试验。

问题与假吸气肌训练和不进行吸气肌训练相比，术前 3 天吸气肌训练（IMT）对心脏瓣膜手术前肺功能以及术后肺功能和肺部并发症有何影响？三臂、多中心、随机对照试验，采用隐蔽分配、意向治疗分析和部分结果的盲法评估：该研究包括228名计划接受心脏瓣膜手术的成人：IMT组接受为期3天的IMT，最大吸气压力为30%；假IMT组接受同样的IMT，但最大吸气压力为10%；对照组不接受IMT：入院时、手术前一天和出院时测量肺活量、最大吸气压力和最大自主通气量。记录术后肺部并发症（主要结果）和不良事件的发生率：共有 215 名参与者按计划完成了手术，所有参与者均接受了随访直至出院。从入院到手术前一天，各组患者的肺活量、最大吸气压力和最大自主通气量均有所改善，但 IMT 组的改善程度更大。出院时，这些指标在所有组别中都有所恶化，但在 IMT 组别中恶化程度较轻。与假IMT组相比（ARR为-0.18，95% CI为-0.33至-0.03），与对照组相比（ARR为-0.21，95% CI为-0.35至-0.05），术前IMT组出现肺部并发症的总人数有所减少。三组患者均很少发生不良反应：术前IMT改善了接受择期心脏瓣膜手术的成人术前和出院时的肺功能，并减少了术后肺部并发症：ChiCTR2100054869。

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来源期刊

Journal of Physiotherapy ORTHOPEDICS-REHABILITATION

CiteScore

11.40

自引率

7.40%

发文量

审稿时长

72 days

期刊介绍： The Journal of Physiotherapy is the official journal of the Australian Physiotherapy Association. It aims to publish high-quality research with a significant impact on global physiotherapy practice. The journal's vision is to lead the field in supporting clinicians to access, understand, and implement research evidence that will enhance person-centred care. In January 2008, the Journal of Physiotherapy became the first physiotherapy journal to adhere to the ICMJE requirement of registering randomized trials with a recognized Trial Registry. The journal prioritizes systematic reviews, clinical trials, economic analyses, experimental studies, qualitative studies, epidemiological studies, and observational studies. In January 2014, it also became the first core physiotherapy/physical therapy journal to provide free access to editorials and peer-reviewed original research. The Australian Physiotherapy Association extended their support for excellence in physiotherapy practice by sponsoring open access publication of all Journal of Physiotherapy content in 2016. As a result, all past, present, and future journal articles are freely accessible, and there are no author fees for publication.