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Preventie van postoperatieve pulmonale complicaties door intensieve preoperatieve ademspiertraining bij hoogrisicopatienten die een bypassoperatie moeten ondergaan: een gerandomiseerde clinische trial (Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery: a randomized clinical trial) [Dutch; with consumer summary]
Hulzebos EHJ, Helders PJM, Favie NJ, de Bie RA, Brutel de la Riviere A, van Meeteren NLU
Nederlands Tijdschrift voor Fysiotherapie [Dutch Journal of Physical Therapy] 2007 Feb;117(1):2-9
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; 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*

CONTEXT: As most coronary artery bypass graft (CABG) surgery is done electively, the pre-hospitalization period leaves time to improve the patient's pulmonary condition. The efficacy of preoperative inspiratory muscle training (IMT) in reducing the incidence of postoperative pulmonary complications (PPCS) in high-risk patients undergoing cabg has not yet been determined. OBJECTIVE: To evaluate the prophylactic efficacy of preoperative IMT on the incidence of ppcs in high-risk patients scheduled for elective CABG. DESIGN, SETTING, AND PATIENTS: Randomized, single-blind clinical trial in a university medical centre in the Netherlands with enrolment between July 2002 and August 2005. Of 655 patients referred for elective CABG, 299 met criteria for being at high risk of developing ppcs, of whom 279 were enrolled and followed up until discharge from hospital. INTERVENTION: Patients were randomly assigned to receive either preoperative IMT (n = 140) or usual care (n = 139). Both groups received the same postoperative physiotherapy. MAIN OUTCOME MEASURES: The primary outcome was the incidence of PPCS, especially pneumonia, and the secondary outcome was duration of postoperative hospitalization. RESULTS: Both groups were comparable at baseline. After CABG surgery, PPCS were present in 25 (18.0%) of the 139 patients in the IMT group and in 48 (35.0%) of the 137 patients in the control group (OR 0.52; 95% CI 0.30 to 0.92). Pneumonia occurred in 9 (6.5%) of the 139 patients in the IMT group and in 22 (16.1%) of the 137 patients in the usual care group (OR 0.40; 95% CI 0.19 to 0.84). The 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 U test; z = -2.42; p = 0.015). CONCLUSIONS: Preoperative imt reduces the incidence of PPCS and the duration of postoperative hospitalization in patients at high risk of developing a pulmonary complication undergoing CABG. TRIAL REGISTRATION: http://www.controlled-trials.com/ISRCTN17691887.

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