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| Preoperatieve ademspiertraining bij patienten die een open hartoperatie moeten ondergaan: een pilotstudie (Preoperative inspiratory muscle training in patients due to undergo open-heart surgery: a pilot study) [Dutch] |
| van den Buijs BJW, Hulzebos HJ, de Bie RA, de la Riviere AB, Helders PJM, van Meeteren NLU |
| Nederlands Tijdschrift voor Fysiotherapie [Dutch Journal of Physical Therapy] 2004 Aug;114(4):104-109 |
| clinical trial |
| 6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed* |
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BACKGROUND AND PURPOSE: Patients undergoing cardiac surgery, such as a coronary artery bypass graft (CABG) procedure, are at high risk of postoperative pulmonary complications (PPCS). Respiratory muscle strength decreases after heart surgery, which may result in respiratory muscle dysfunction and respiratory failure, possibly leading to PPCS. Preoperative inspiratory muscle training (IMT) may prevent this ventilatory dysfunction. The aim of this study was to investigate the effect of preoperative IMT in patients at high risk of a PPC who underwent cast surgery and to determine whether results would justify a randomized clinical trial. SUBJECTS AND METHODS: In this single blind, randomized controlled pilot study, patients at high risk of developing a PPC were preoperatively selected using a validated risk model (Hulzebos et al, 2003). The participants in the intervention group received preoperative IMT whereas patients in the control group received care as usual. The primary outcome parameter was the practicality of the intervention (participant satisfaction, motivation, compliance, and occurrence of adverse effects), and secondary outcome parameters were inspiratory muscle strength, lung function, heart rate, and blood pressure responses during IMT. RESULTS: Forty patients, all candidates for elective coat, were recruited. No participants dropped out during the experiment and no adverse effects of IMT were observed in the intervention group. Treatment satisfaction, compliance, and motivation were high. Inspiratory muscle strength (PImax) increased significantly in the intervention group and non-significantly in the control group. The small number of patients and the large variation in results meant that there were no statistically significant differences in inspiratory muscle strength between the two groups. CONCLUSION: IMT for 2 to 4 weeks before cast surgery led to a significant increase in inspiratory muscle strength and was well tolerated by patients at risk of developing a PPC. Whether IMT leads to a clinically relevant effect should be investigated in a randomized clinical trial.
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