Evaluation of the effectiveness of preoperative outpatient pulmonary preparation in patients undergoing esophageal surgery

Fernanda Maria Rodrigues Da Cunha,Paulo Fernando De Oliveira,Márcia Souza Volpe,Marisa De Carvalho Borges,Júlia Maria Vergani Fanan,Eduardo Crema

doi:10.1590/1980-5918.031.ao06

Fernanda Maria Rodrigues Da Cunha, Paulo Fernando De Oliveira + Show 4 more

Open Access

https://doi.org/10.1590/1980-5918.031.ao06

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Abstract

Abstract Introduction: Preoperative inspiratory muscle training (IMT) can minimize the occurrence of complications after esophagectomy. Objective: To evaluate the effects of preoperative IMT in patients undergoing esophageal surgery by determining respiratory muscle strength (PImax and PEmax), pulmonary function (FEV1, FVC, FEV1/FVC) and functional capacity by the 6-minute walk test (6MWT). Methods: Twenty-two patients were randomized into two groups: a control group (CG; n = 10) and an intervention group (IG; n = 12). Only IG performed IMT for a minimum period of 2 weeks. The assessments were conducted pre- and post-surgery. Results: An increase of PImax was observed in IG, but not in CG, in the second preoperative assessment (p = 0.014). Assessment on postoperative day 1 showed a reduction in maximal respiratory pressures in the two groups, but the reduction was more marked in IG (p < 0.05). Partial recovery of the variables evaluated was observed at discharge in the two groups. These variables had fully returned to initial values on postoperative day 30. The distance walked in the 6MWT was greater in IG, but the difference was not significant (p = 0.166). There was no difference in the frequency of pulmonary complications between groups. Conclusion: Preoperative IMT performed in our study improved inspiratory muscle strength but did not influence the postoperative pulmonary function or functional capacity of patients undergoing esophagectomy.

Highlights

Preoperative inspiratory muscle training (IMT) can minimize the occurrence of complications after esophagectomy
Preoperative IMT performed in our study improved inspiratory muscle strength but did not influence the postoperative pulmonary function or functional capacity of patients undergoing esophagectomy
In addition to the exercise leaflets, the patients received a Threshold IMT provided by HC-UFTM so that they could perform the intervention proposed at home

Summary

Introduction

Preoperative inspiratory muscle training (IMT) can minimize the occurrence of complications after esophagectomy. Objective: To evaluate the effects of preoperative IMT in patients undergoing esophageal surgery by determining respiratory muscle strength (PImax and PEmax), pulmonary function (FEV1, FVC, FEV1/FVC) and functional capacity by the 6-minute walk test (6MWT). Partial recovery of the variables evaluated was observed at discharge in the two groups These variables had fully returned to initial values on postoperative day 30. Conclusion: Preoperative IMT performed in our study improved inspiratory muscle strength but did not influence the postoperative pulmonary function or functional capacity of patients undergoing esophagectomy. Eight to 40% of patients with Chagas disease develop different degrees of esophageal manifestations, which represent a large socioeconomic problem in Brazil and reduce the quality of life of patients due to dysphagia, which is often severe [2]. The onset of dysphagia before the age of 40 is observed in 80% of cases [4]

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