OBJECTIVE: The aim of this study was to evaluate the prophylactic efficacy of preoperative physiotherapy, including inspiratory muscle training (IMT), on the incidence of postoperative pulmonary complications (PPCs) in high-risk patients scheduled for elective coronary artery bypass grafting (CABG). DESIGN: Randomized controlled clinical trial (www.controlled-trials.com/ISRCTN17691887). METHOD: Of 655 patients referred to a university medical centre in the Netherlands for elective CABG, 299 met the criteria for being at high risk of developing PPCs. A total of 279 were enrolled and monitored up to discharge from hospital. Patients were randomly assigned to receive either preoperative IMT (n = 140) or usual care (n = 139). Both groups received the same postoperative treatment. RESULTS: Both groups were comparable at baseline. Before CABG, 2 control group patients and 1 IMT: group patient died. After CABG surgery, PPCs were present in 25 (18%) of 139 patients in the IMT group and 48 (35%) of 137 patients in the control group (OR 0.52; 95% CI 0.30 to 0.92). Pneumonia occurred in 9 (6.5%) of 139 patients in the IMT group and in 22 (16.1%) of 137 patients in the usual care group (OR 0.40; 95% CI 0.19 to 0.84). Mean duration of postoperative hospitalization was 7 (range 5 to 41) days in the IMT group versus 8 (range 6 to 70) days in the usual care group (Mann-Whitney test; z = -2.42; p = 0.015). CONCLUSION: Preoperative physiotherapy, including IMT, statistically significantly reduced the incidence of PPCs and the duration of postoperative hospitalization in patients at high risk of developing a pulmonary complication on undergoing CABG.

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