Abstract
BackgroundIn patients undergoing open cardiothoracic and upper abdominal surgery, postoperative pulmonary complications remain an important cause of postoperative morbidity and mortality, impacting upon hospital length of stay and health care resources. Adequate preoperative respiratory muscle strength may help protect against the development of postoperative pulmonary complications and therefore preoperative inspiratory muscle training has been suggested to be of potential value in improving postoperative outcomes.Methods/DesignA systematic search of electronic databases will be undertaken to identify randomized trials of preoperative inspiratory muscle training in patients undergoing elective open cardiothoracic and upper abdominal surgery. From these trials, we will extract available data for a list of predefined outcomes, including postoperative pulmonary complications, hospital length of stay and respiratory muscle strength. We will meta-analyze comparable results where possible, and report a summary of the available pool of evidence.DiscussionThis review will provide the most comprehensive answer available to the question of whether preoperative inspiratory muscle training is clinically useful in improving postoperative outcomes in patients undergoing cardiothoracic and upper abdominal surgery. It will help inform clinicians working in the surgical arena of the likely effectiveness of instituting preoperative inspiratory muscle training programs to improve postoperative outcomes.
Highlights
In patients undergoing open cardiothoracic and upper abdominal surgery, postoperative pulmonary complications remain an important cause of postoperative morbidity and mortality, impacting upon hospital length of stay and health care resources
This review will provide the most comprehensive answer available to the question of whether preoperative inspiratory muscle training is clinically useful in improving postoperative outcomes in patients undergoing cardiothoracic and upper abdominal surgery
It will help inform clinicians working in the surgical arena of the likely effectiveness of instituting preoperative inspiratory muscle training programs to improve postoperative outcomes
Summary
In patients undergoing open cardiothoracic and upper abdominal surgery, postoperative pulmonary complications remain an important cause of postoperative morbidity and mortality, impacting upon hospital length of stay and health care resources. Patients develop predictable pulmonary changes that include altered respiratory mechanics, reduced lung volumes, respiratory muscle dysfunction and alterations in oxygenation status. These changes may be transient and self-resolving or may predispose patients to the development of more substantial. Whilst currently the concept of prehabilitation and the evidence for its effectiveness are in their infancy, the main aims of prehabilitation are to improve postoperative outcomes and reduce postoperative risk Those studies that have investigated prehabilitation have used a variety of preoperative exercise interventions across a spectrum of clinical settings, including joint replacement surgery and cardiac, thoracic and abdominal surgery [12]. The concept of prehabilitation to improve functional capacity before and after anticipated admission to intensive care has been considered [11]
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