Perioperative Pulmonary Rehabilitation Research Articles

The effect of a hybrid structured pulmonary rehabilitation education program for patients with lung cancer with a high risk of postoperative pulmonary complications: A quasi-experimental study

PurposeThe absence of standardized protocols and education are the main obstacles to perioperative pulmonary rehabilitation (PR), especially for patients with high-risk factors of postoperative pulmonary complications (PPCs). We aimed to explore the effect of a hybrid structured pulmonary rehabilitation education program (SPREP) on patients with lung cancer at high risk of PPCs. MethodsA quasi-experimental trial with a pre-post test design was conducted. The control group (n = 53) adopted routine perioperative pulmonary rehabilitation, while the intervention group (n = 53) received SPREP. Respiratory function, 6-min walk distance, Borg dyspnea scale, quality of life, anxiety–depression scores at admission, discharge, 2 weeks and 3 months post-discharge, and incidence of PPCs were compared between the two groups. ResultsThere were no significant differences on the 6-min walk distance and Borg Dyspnoea Scale at discharge between the two groups (P > 0.05), whereas the intervention group showed improved performance at the remaining time points (P < 0.05). In addition, the intervention group had improved exercise capacity, pulmonary function and quality of life, reduced levels of anxiety and depression at discharge, 2 weeks post-discharge and 3 months post-discharge (P < 0.05). In addition, incidence of PPCs was significantly reduced in the intervention group, especially postoperative pneumonia. ConclusionsThe SPREP could show significant benefits in enhancing exercise capacity, lung function, and quality of life, while diminishing the occurrence of PPCs and mitigating the levels of anxiety and depression, future large RCT need to further explore the efficacy. Trial registrationThis study was registered with the China Clinical Trial Registration Center (ChiCTR) under the Clinical Trial Registration Number [ChiCTR2200066698].

Effectiveness of preoperative and perioperative pulmonary rehabilitation nursing program for the management of patients undergoing thoracic surgery: A systematic review and meta-analysis

Background &amp; Objective: Several studies have investigated the effectiveness of preoperative or perioperative pulmonary rehabilitation in thoracic surgery patients, but the results are inconsistent and inconclusive. This study attempts to summarize the existing data on the effect of the preoperative and perioperative pulmonary rehabilitation nursing program for the management of patients undergoing thoracic surgery. Methods: Systematic search was done in PubMed Central, SCOPUS, EMBASE, MEDLINE, Google Scholar, and ScienceDirect for papers published until December 2022 and reporting data of postoperative complications and pulmonary health status in patients undergoing thoracic surgery and receiving preoperative or perioperative pulmonary rehabilitation nursing intervention or standard care. Meta-analysis was done by random-effects model and pooled standardised mean differences (SMD) or odds ratios (OR) along with 95% confidence intervals (CIs) were reported. Results: Eighteen studies were included and analysed. Pooled SMD was 0.44 (95%CI: -0.21 to 1.08) for forced expiratory volume (FEV-1), -0.34 (95%CI: -0.94 to 0.26) for peak expiratory flow (PEF), 0.61 (95%CI: -0.60 to 1.81) for forced vital capacity (FVC), 0.42 (95%CI: -0.13 to 0.98) for diffusing capacity of carbon monoxide (DLCO). Pooled SMD for length of hospital stay was -0.64 (95%CI: -1.09 to -0.19). Pooled OR was 0.87 [95%CI: 0.32 to 2.37] for all-cause mortality, 0.35 [95%CI: 0.25 to 0.50] for postoperative pulmonary complications, 0.98 [95%CI: 0.45 to 2.12] for respiratory failure, 0.52 [95%CI: 0.38 to 0.78] for pneumonia and 0.50 [95%CI: 0.33 to 0.76] for atelectasis. Conclusion: Perioperative pulmonary rehabilitation nursing program is effective in reducing the postoperative lung complications and shortening the length of hospital stay in patients undergoing thoracic surgery. doi: https://doi.org/10.12669/pjms.40.6.9259 How to cite this: Xu M, Yang X, Guo L. Effectiveness of preoperative and perioperative pulmonary rehabilitation nursing program for the management of patients undergoing thoracic surgery: A systematic review and meta-analysis. Pak J Med Sci. 2024;40(6):1280-1286. doi: https://doi.org/10.12669/pjms.40.6.9259 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Sex Differences in Outcomes of Hepatobiliary and Pancreatic Surgery with Accelerated Rehabilitation.

Sex, in the sense of gender, is a major social demographic characteristic that has been shown to affect health care outcomes. The concept of enhanced recovery after surgery (ERAS) is an effective perioperative management measure that can reduce the perioperative stress response in patients. However, there are few studies on the differences between male and female patients under this type of care. We aimed to analyze sex differences in clinical characteristics among patients undergoing hepatobiliary and pancreatic surgery with accelerated rehabilitation. We enrolled patients who underwent liver, biliary tract, and gallbladder operations in the Department of Hepatobiliary and Pancreatic Surgery of Taizhou Hospital, Zhejiang Province, China, from April 2021 to July 2021. Key measures were collected for patients undergoing perioperative accelerated rehabilitation (i.e., the case group). The study group was assembled by performing 1:1 matching for age, sex, chronic disease, and type of surgery. Postoperative risk assessment, postoperative recovery indicators, and postoperative length of hospital stay (days) were compared between male and female patients. A total of 226 surgical patients were enrolled, including 109 male (48.23%) and 117 female patients (51.77%). The outcomes, presented as the median (min, max), were as follows: pulmonary rehabilitation risk assessment in females (1(0,3)) and males (0(0,2)), postoperative nausea and vomiting in females (2(1,3)) and males (1(0,2)), and time to first defecation in females (31(4,61)) and males (36(10,78)). Significant differences were indicated by p values < 0.05. We identified sex differences in the clinical prognosis and performance of perioperative patients undergoing hepatobiliary and pancreatic surgery with accelerated rehabilitation. The perioperative pulmonary rehabilitation risk of male patients was higher than that of female patients, and the time to first defecation was longer in male than in female patients. The incidence of nausea and vomiting in women was higher than in men.

The effect of incentive spirometry in perioperative patients with lung cancer—a systematic review and meta-analysis

BackgroundIncentive spirometry (IS) as a routine respiratory therapy during the perioperative period has been widely used in clinical practice. However, the impact of IS on patients with perioperative lung cancer remains controversial. This review aimed to evaluate the efficacy of IS in perioperative pulmonary rehabilitation for patients with lung cancer.MethodsCochrane Library, PubMed, Web of Science, Ovid, CINAHL, Chinese National Knowledge Infrastructure, Weipu, and Wanfang Databases were searched from inception to 30 November 2023. Only randomized controlled trials were included in this systematic review. The PRISMA checklist served as the guidance for conducting this review. The quality assessment of the included studies was assessed by the Cochrane risk-of-bias tool. The meta-analysis was carried out utilizing Review Manager 5.4. Furthermore, sensitivity analysis and subgroup analysis were also performed.ResultsNine studies recruited 1209 patients met our inclusion criteria. IS combined with other respiratory therapy techniques was observed to reduce the incidence of postoperative pulmonary complications, enhance pulmonary function, curtail the length of hospital stay, and lower the Borg score. Nevertheless, no improvements were found in the six-minute walk distance or quality of life score.ConclusionsAlthough IS demonstrates benefits as a component of comprehensive intervention measures for perioperative patients with lung cancer, it proves challenging to determine the precise impact of IS as a standalone component within the comprehensive intervention measures. Therefore, further researches are required to better understand the effectiveness of IS isolation and its interactions when integrated with additional respiratory therapies for these patients.Clinical trial registrationPROSPERO, https://www.crd.york.ac.uk/prospero/, registry number: CRD42022321044.

Development and testing of the knowledge–attitudes–practices questionnaire for nurses on the perioperative pulmonary rehabilitation of patients with lung cancer

ObjectiveThis study aims to develop and validate a suitable scale for assessing the level of nurses' knowledge and practice of perioperative pulmonary rehabilitation. MethodsWe divided the study into two phases: scale development and validation. In Phase 1, the initial items were generated through a literature review. In Phase 2, a cross-sectional survey was conducted involving 603 thoracic nurses to evaluate the scale's validity, reliability, and difficulty and differentiation of items. Item and exploratory factor analyses were performed for item reduction. Thereafter, their validity, reliability, difficulty, and differentiation of items were assessed using Cronbach's α coefficient, retest reliability, content validity, and item response theory (IRT). ResultsThe final questionnaire comprised 34 items, and exploratory factor analysis revealed 3 common dimensions with internal consistency coefficients of 0.950, 0.959, and 0.965. The overall internal consistency of the scale was 0.966, with a split-half reliability of 0.779 and a retest reliability Pearson's correlation coefficient of 0.936. The content validity of the scale was excellent (item-level content validity index = 0.875–1.000, scale-level content validity index = 0.978). The difficulty and differentiation of item response theory were all verified to a certain extent (average value = 2.391; threshold β values = −1.393–0.820). ConclusionsThe knowledge–attitudes–practices questionnaire for nurses can be used as a tool to evaluate knowledge, attitudes, and practices among nurses regarding perioperative pulmonary rehabilitation for patients with lung cancer.

Development of a real-time RGB-D visual feedback-assisted pulmonary rehabilitation system

BackgroundFollowing surgery, perioperative pulmonary rehabilitation (PR) is important for patients with early-stage lung cancer. However, current inpatient programs are often limited in time and space, and outpatient settings have access barriers. Therefore, we aimed to develop a background-free, zero-contact thoracoabdominal movement-tracking model that is easily set up and incorporated into a pre-existing PR program or extended to home-based rehabilitation and remote monitoring. We validated its effectiveness in providing preclinical real-time RGB-D (colour-depth camera) visual feedback. MethodsTwelve healthy volunteers performed deep breathing exercises following audio instruction for three cycles, followed by audio instruction and real-time visual feedback for another three cycles. In the visual feedback system, we used a RealSense™ D415 camera to capture RGB and depth images for human pose-estimation with Google MediaPipe. Target-tracking regions were defined based on the relative position of detected joints. The processed depth information of the tracking regions was visualised on a screen as a motion bar to provide real-time visual feedback of breathing intensity. Pulmonary function was simultaneously recorded using spirometric measurements, and changes in pulmonary volume were derived from respiratory airflow signals. ResultsOur movement-tracking model showed a very strong correlation (r = 0.90 ± 0.05) between thoracic motion signals and spirometric volume, and a strong correlation (r = 0.73 ± 0.22) between abdominal signals and spirometric volume. Displacement of the chest wall was enhanced by RGB-D visual feedback (23 vs 20 mm, P = 0.034), and accompanied by an increased lung volume (2.58 vs 2.30 L, P = 0.003). ConclusionWe developed an easily implemented thoracoabdominal movement-tracking model and reported the positive impact of real-time RGB-D visual feedback on self-promoted external chest wall expansion, accompanied by increased internal lung volumes. This system can be extended to home-based PR.

Effectiveness and quality of life in lung cancer, pre-, post- and perioperative rehabilitation - Areview.

Functional conditions like lung function and exercise capacity are important limiting factors of chest surgery in lung cancer with co-morbidities (chronic obstructive pulmonary disease (COPD) and other chronic respiratory diseases). Pulmonary rehabilitation has a favourable effect on the cardiovascular system, metabolism, respiratory and peripheral muscles and lung mechanics. Our aim was to assess the role of pre-, post- and peri-operative pulmonary rehabilitation in lung cancer in this review. We sought to size up the importance of pulmonary rehabilitation in patients undergoing surgery with or without (neo)adjuvant treatment, radiotherapy, chemotherapy, chemoradiotherapy, major physiological impairments and complications.Searches were performed in PubMed and ClinicalTrials.gov databases using the terms "exercise", "rehabilitation", "small cell lung cancer", "non-small cell lung cancer", "exercise capacity", "chest surgery" and "quality of life" from inception to February 7th, 2022. Pulmonary rehabilitation has been recognized as an effective intervention to reduce lung cancer related symptoms and improve the pulmonary function, lung mechanics, chest kinematics, respiratory- and peripheral muscle function, physical activity and quality of life (QoL) of the patients. In conclusion, this review shows positive, highly encouraging and effective results of pulmonary rehabilitation in terms of the patients' lung function, functional mobility and quality of life. The tools for complex pulmonary rehabilitation have evolved considerably over the past two decades, thus this research has been conducted on a variety of studies about this subject and serves as a synthesis of the systematic and meta-analytic reviews.

Perioperative Pulmonary Rehabilitation for Lung Surgery

呼吸器外科手術の周術期呼吸リハビリテーションについて，術前リハ，術後リハ，術前・術後リハ，ERAS，Incentive Spirometry（IS）のメタ分析の結果を中心に概説した．術前リハは少なくとも2週間必要で，肺合併症の変更可能な危険因子をできるだけ改善させておく．術後はERASを導入し，呼吸管理，早期離床，疼痛コントロール，IS，呼吸理学療法など包括的早期介入が有効で，術後安定期にも有酸素運動を中心とした術後リハを行うべきである．周術期呼吸リハにより，術後肺合併症・肺炎・在院日数・胸腔ドレーンの減少，運動耐容能・身体活動量・大腿四頭筋力・呼吸機能・呼吸筋力・HRQOL・呼吸困難・疲労が改善するが，現在，死亡率の改善は困難である．しかし，今後の可能性を秘めている．

Rehabilitation for lung cancer patients undergoing surgery: results of the PUREAIR randomized trial.

Surgery for non-small cell lung cancer is proven to be the most effective treatment in early stages, although concerns exist on its negative impact on patients' overall fitness. To establish whether intensive pulmonary rehabilitation, preoperative and postoperative, improves exercise capacity in patients undergoing lung resection. Single center, unblinded, designed for superiority, 1:1 randomized controlled trial with two parallel arms. S. Maria Nuova Hospital of Reggio Emilia (Reggio Emilia, Italy). Patients referred from local lung cancer multidisciplinary team for lung resection. Patients were randomized to either standard of care (SC) or SC + intensive perioperative pulmonary rehabilitation (SC+PR). The primary aim was to investigate the effectiveness of pulmonary rehabilitation in improving exercise capacity six months after surgery. Additionally, we wanted to investigate the same effect shortly after surgery (at one month), as well as the overall impact of rehabilitation on lung function, postoperative complications and length of stay, quality of life, mood disturbances and pain. Sample was sized based on the primary outcome assuming a minimal clinically significant difference of 25 meters in exercise tolerance, measured with 6 minutes walking test. The exercise tolerance at 6 months after surgery was significantly higher in patients undertaking PR compared to SC (+48.9 meters vs. -7.5 meters respectively, difference: +56.4 meters, 95% CI: 29.6-83.0, P<0.001) and it showed significantly lower impairment at 1 month after surgery in the intervention group (-3.0 meters vs. -30.1 meters difference: +27.1 meters, 95% CI: 3.4-50.8, P=0.025). No other significant differences between groups were found. Comparison between groups showed that pulmonary rehabilitation, administered pre and postoperatively, significantly improved exercise capacity at 6 months in patients undergoing lung resection; it also significantly reduced the decrease in exercise tolerance observed 1 month after surgery. The PUREAIR trial highlights the importance of combined preoperative and postoperative rehabilitation in reducing physical deconditioning in lung cancer patients undergoing surgery. Comprehensive pulmonary rehabilitation improves exercise capacity at 1 and 6 months after surgery. The PUREAIR trial results increase knowledge on comprehensive rehabilitation's outcomes in the first six months after surgery.

The effectiveness of pulmonary rehabilitation in connection with lung transplantation in Hungary.

The role of pre- and post-lung transplant rehabilitation is to maintain or improve exercise tolerance, lung mechanics, peripheral and respiratory muscle function. Our aim was to measure the effectiveness of pre- and post-transplant rehabilitation in terms of the changes of functional and quality of life markers. Sixty-three patients (40 COPD FEV1: 21±5%pred, 18 IPF TLC: 42±13%pred, 4 bronchiectasis FEV1: 28±4%pred and 1 alveolitis fibrotisans TLC: 31%pred) participated in a pre- and 14 took part in a post-transplant rehabilitation program (more than 2 months after lung transplantation (LTx), primary diagnoses: 9 COPD, 4 IPF). The rehabilitation program consisted of chest-wall stretching, controlled breathing techniques and personalized exercise of 20-30 minutes by cycling and treadmill 2-3 times per day for 4 weeks. Seven functional and quality of life markers, like lung function, chest wall expansion (CWE), 6-minute walking distance (6MWD), modified Medical Research Council Dyspnea Scale (mMRC), COPD Assessment Test (CAT), breath holding time (BHT) and hand grip strength (HGS) were measured at the onset and the end of the rehabilitation program. The safety profile of the rehabilitation program was followed-up. Pre-transplant pulmonary rehabilitation resulted in significant improvement in CWE (3.24±1.49 vs. 4.48±1.62 cm), CAT IQR {19 [13-25] vs. 15 [11-21]}, 6MWD (315±118 vs. 375±114 m), P<0.05. FEV1, FVC, mMRC, BHT and HGS did not change significantly. Post-transplant rehabilitation resulted in significant improvement in CWE (3.7±2.1 vs. 6.2±1.8 cm), CAT IQR {17 [11-23] vs. 10 [6-14], BHT (22±14 vs. 35±16 s), FEV1 (73±8 vs. 86±9%pred) and FVC (70±12 vs. 85±14%pred), P<0.05. The 6MWD, mMRC and HGS did not change significantly. No cardiovascular or other side effects were detected during the rehabilitation program. Our results underline the importance of perioperative pulmonary rehabilitation in the complex treatment of lung transplant patients in Hungary, as well. There was a limitation because no control group was evaluated without rehabilitation.

Perioperative pulmonary rehabilitation training (PPRT) can reduce the cost of medical resources in patients undergoing thoracoscopic lung cancer resection: a retrospective study.

To evaluate the benefits of perioperative pulmonary rehabilitation training (PPRT) in patients undergoing thoracoscopic lung cancer resection. The clinical data of 1,427 patients undergoing thoracoscopic lung cancer resection were collated. Of these patients, 779 received PPRT (the PPRT group), which included systematic education, improvement of posture, diaphragmatic respiration, bilateral lower thoracic expansion, surgical side thoracic local expansion, incentive spirometry training, effective cough training, aerobic walking, and other systematic pulmonary rehabilitation training. The other 648 patients did not receive PPRT (the non-PPRT group). Baseline characteristics including length of hospital stay, cost of hospitalization, and the incidence of postoperative pulmonary complications (PPCs) were assessed. There was no significant difference between the PPRT group and the non- PPRT group in terms of age, gender distribution, tumor location, operation mode, postoperative pathological type, TNM stage, and other baseline characteristics (P>0.05). The complication index of the PPRT group was slightly higher than that of the non-PPRT group (P<0.05). Patients in the PPRT group had significantly fewer postoperative hospitalization days (PHD) {6.1 days [95% confidence interval (CI): 5.8 to 6.4] vs. 6.4 days (95% CI: 6.1 to 6.7), P=0.002}, fewer total hospitalization days (THD) [9.3 days (95% CI: 8.9 to 9.7) vs. 10.8 days (95% CI: 10.3 to 11.3), P=0.000], lower non-surgical expenses (35,024±9,742 vs. 36,831±10,245 RMB), and fewer cases of PPCs) (3.72% vs. 6.33%, P=0.016) compared to patients in the non-PPRT group. In the subgroup analysis, patients less than 60 years old in the PPRT group fared better in terms of the PHDs, total inpatient days, and non-surgical expenses compared to patients in the non-PPRT group (P<0.05). In patients aged 60 years and older, the THDs in the PPRT group was less than that in the non-PPRT group (P<0.05), but there were no significant differences in the PHDs and non-surgical expenses. PPRT can reduce the cost of medical resources in patients undergoing thoracoscopic lung cancer resection, especially by shortening the length of hospital stay, reducing the cost of hospitalization, and reducing PPCs.

Long-term survival following lung surgery for cancer in high-risk patients after perioperative pulmonary rehabilitation.

The benefits of a rehabilitation programme before lung surgical resection for cancer remain to be defined. The purpose of this observational study was to assess the efficacy of preoperative rehabilitation and postoperative rehabilitation on short- and long-term outcomes in patients who were at high operative risk. Between January 2010 and December 2012, 20 consecutive non-operable patients (16 men and 4 women, mean age 66 years) with clinical N0 lung cancer were included. Eligibility criteria were lung function below guideline thresholds and/or associated severe comorbidities. The protocol included a cardiorespiratory perioperative rehabilitation programme. These patients were followed up at 5 years. The average increase in forced expiratory volume (FEV)1 and of VO2max preoperatively was 12% and 3.5 ml/kg/min, respectively. All patients underwent a pulmonary surgical resection procedure. The morbidity and mortality rates were 20% and 5%, respectively. Nineteen patients returned home upon the completion of postoperative rehabilitation. After 5-year follow-up, the Kaplan-Meier 5-year survival rate was 52%. Perioperative pulmonary rehabilitation seems to allow surgical management of lung cancer by lung resection in first-line, non-eligible patients. The long-term survival of operated high-risk patients is encouraging despite the high complication rate.

Clinical characteristics of chronic obstructive pulmonary disease in patients with non-small-cell lung cancer

Objective To explore the clinical characteristics and perioperative treatment of chronic obstructive pulmonary disease (COPD) in patients with non-small-cell lung cancer (NSCLC) in department of thoracic surgery, and to guide the clinical diagnosis and treatment. Methods From January 2013 to December 2016, patients with newly diagnosed NSCLC treated in the thoracic surgical department of Lanzhou University Second Hospital were reviewed retrospectively.The patients were divided into the COPD group and non-COPD group.The clinical data, including the incidence and clinical characteristics of COPD in non-small-cell lung cancer, pulmonary complications after surgery, COPD diagnosis and perioperative pulmonary rehabilitation were analyzed retrospectively. Results A total of 726 NSCLC patients were reviewed, six hundred and seventy-five cases who took the full lung function test were included in the study, of which 95 cases received bronchial diastolic test, 86 cases were accorded with COPD diagnosis and were included in incorporated COPD group, and 589 cases were in the non- incorporated COPD group.The proportion of men (69 cases, 80.2%, χ2=24.032), age ≥65 (51 cases, 59.3%, χ2=6.784), smoking history (55cases, 64.0%, χ2=29.474) and a large number of smokers (43 cases, 50.0%, χ2=5.802) and lung squamous cell carcinoma(47 cases, 54.7%, χ2=6.241) in the incorporated COPD group were higher than those in differences were statistically significant (P<0.05); the incidence of pulmonary complications after radical resection of lung cancer in the incorporated COPD group was 23.9% (16/67), which was significantly higher than that in the unincorporated COPD group(13.7% (78/568)) (χ2=4.894, P<0.05). The incidence of pulmonary complications in the lung rehabilitation group was 13.5% (5/37), lower than that of the non-lung rehabilitation group (36.7% (11/30)) (χ2=4.886, P<0.05); Among the 86 cases (12.7%) of incorporated COPD, only 6 cases (8.9 ‰) were diagnosed with COPD at the time of admission, and 23 cases (3.4%) at discharge.No COPD guidelines were given. Conclusion NSCLC often combined wtith COPD, especially in males, elders (≥65 years old), smokers, squamous cell carcinoma patients.At present, the diagnosis and treatment of co-morbidity of COPD is seriously inadequate, which needs to be paid much attention to by the thoracic surgeons, in order to improve the diagnosis and treatment of COPD, and improve the prognosis of the patients with NSCLC and COPD. Key words: Non-small-cell lung cancer; Chronic obstructive pulmonary disease; Pulmonary function tests; Pulmonary rehabilitation; Complication

Effectiveness of pulmonary rehabilitation and correlations in between functional parameters, extent of thoracic surgery and severity of post-operative complications: randomized clinical trial.

Pulmonary rehabilitation can be effective in perioperative condition. Our aim was to examine whether the changes of functional markers are significant and search connections between these values and the severity of postoperative complications. A total of 238 chronic obstructive pulmonary disease (COPD) patients underwent perioperative pulmonary rehabilitation with thoracic surgery. Health status and the following parameters were examined: lung function (FEV1, FVC), chest kinematics [chest wall expansion (CWE)], 6-minute walking test (6MWT), breath holding time (BHT), grip strength (GS) and exercise capacity. Patients were separated into three groups: 72 patients had preoperative rehabilitation only (PRE group), 80 had only postoperative rehabilitation (POS group), and 86 patients underwent pre- and postoperative rehabilitation as well (PPO group). Postoperative complications were classed as "severe" and "not severe". We evaluated the changes in functional parameters. Significance was recognized at P<0.05. Connections in between variables and severity of complications were analyzed. Pulmonary rehabilitation resulted significant changes of all examined parameters in all three groups. The direction of changes were favourable, so all of the changes can be considered to be improvement [PRE: CWE: 4.2±2.3 vs. 5.8±2.2 cm; FEV1: 63.2±15.6 vs. 70.1±16.6%pred; 6-minute walking distance (6MWD): 392.9±93.5 vs. 443.2±86.6 m; FVC: 83.1±15.9 vs. 90.9±15.6%pred; POS: CWE: 2.9±1.4 vs. 5.0±2.0 cm; FEV1: 56.4±15.6 vs. 64.6±16.0%pred; 6MWD: 354.7±90.7 vs. 437.0±96.0 m; FVC: 66.2±18.7 vs. 76.1±17.7%pred; PPO: preoperatively: CWE: 4.0±2.1 vs. 5.6±2.6 cm; FEV1: 58.2±15.1 vs. 67.0±14.6%pred; 6MWD: 378.3±90.5 vs. 441.3±86.4 m; FVC: 82.4±16.7 vs. 93.3±16.7%pred; postoperatively: CWE: 2.7±1.5 vs. 4.4±2.2 cm; FEV1: 47.4±13.0 vs. 53.4±14.7%pred; 6MWD: 341.4±115.9 vs. 403.3±98.4 m; FVC: 63.6±16.9 vs. 72.6±18.6%pred; P<0.05]. BHT, GS, dyspnoea and health status were also improved significantly. By discriminant analysis 5 of the variables proved to have discriminative value: kilometers travelled via cycle ergometer at the onset of the preoperative rehabilitation, gender, FEV1 after preoperative rehabilitation, extent of the operation and 6MWD before preoperative rehabilitation. These 5 parameters can predict severe complications correctly in 72.5% of all cases. Pulmonary rehabilitation can reduce the functional depletion caused by the thoracic surgical operation. Identification of more predictive factors of severe complications can help making preoperative risk stratification more precisely.

Effectiveness of a perioperative pulmonary rehabilitation program following coronary artery bypass graft surgery in patients with and without COPD

PurposeIt is unclear whether the effectiveness of pulmonary rehabilitation program (PRP) after cardiac surgery differs between patients with and without COPD. This study aimed to compare the effectiveness of PRP between patients with and without COPD undergoing coronary artery bypass graft (CABG) surgery.Patients and methodsWe retrospectively included patients who underwent CABG surgery and received 3-week PRP from January 2009 to December 2013. We excluded patients who underwent emergency surgery, had an unstable hemodynamic status, were ventilator dependent or did not complete the PRP. Demographics, muscle strength, degree of dyspnea, pulmonary function and postoperative complications were compared.ResultsSeventy-eight patients were enrolled (COPD group, n=40; non-COPD group, n=38). Maximal inspiratory pressure (MIP; −34.52 cmH2O vs −43.25 cmH2O, P<0.01; −34.67 cmH2O vs −48.18 cmH2O, P<0.01), maximal expiratory pressure (MEP; 32.15 cmH2O vs 46.05 cmH2O, P<0.01; 37.78 cmH2O vs 45.72 cmH2O, P<0.01) and respiratory rate (RR; 20.65 breath/minute vs 17.02 breath/minute, P<0.01; 20.65 breath/minute vs 17.34 breath/minute, P<0.01) in COPD and non-COPD groups, respectively, showed significant improvement, but were not significantly different between the two groups. Forced vital capacity (FVC; 0.85 L vs 1.25 L, P<0.01), forced expiratory volume in 1 second (FEV1; 0.75 L vs 1.08 L, P<0.01), peak expiratory flow (PEF; 0.99 L vs 1.79 L, P<0.01) and forced expiratory flow between 25% and 75% of vital capacity (FEF25–75; 0.68 L vs 1.15 L, P<0.01) showed significant improvement between postoperative Days 1 and 14 in the COPD group. FVC (1.11 L vs 1.36 L, P<0.05), FEV1 (96 L vs 1.09 L, P<0.05) and FEF25–75 (1.03 L vs 1.26 L, P<0.05) were significantly improved in the non-COPD group. However, only PEF (80.8% vs 10.1%, P<0.01) and FEF25–75 (67.6% vs 22.3%, P<0.05) were more significantly improved in the COPD group than in the non-COPD group.ConclusionPRP significantly improved respiratory muscle strength and lung function in patients with and without COPD who underwent CABG surgery. However, PRP is more effective in improving PEF and FEF25–75 in COPD patients.

Effect of preoperative pulmonary pehabilitation in patients with lung cancer: a Meta-analysis

Objective To evaluate the efficacy of preoperative pulmonary rehabilitation in patients with lung cancer. Methods We searched Cochrane Library, Web of Science, Pubmed, Embase, CNKI, Wan Fang Date, Vip Date and CBM to collect randomized controlled trials (RCTs) or quasi-experimental study about perioperative pulmonary rehabilitation applied in lung cancer patients, the retrieval time was from 1990 to 2017. The data was analyzed by RevMan 5.3 software after two researchers independently screened the literature, extracted the data, and evaluated the biased risk of inclusion studies. Results A total of 16 studies were included, including 904 patients, and 8 of them were RCT, and 8 quasi-experimental studies. The results of meta-analysis showed that patients after preoperative pulmonary rehabilitation their the first-second forced expiratory volume (FEV1) was increased (MD=0.20, 95%CI: 0.02-0.37, P=0.03) , preoperative forced vital capacity (FVC) was increased (MD=0.22, 95%CI: 0.05-0.38, P=0.009) , preoperative distance of 6-minute walking test (6MWT) was increased (MD=44.07, 95%CI: 33.88-54.27, P<0.001) , the postoperative hospital stay in the preoperative pulmonary rehabilitation group was shortened (MD=-2.28, 95%CI: -2.77-1.79, P<0.001) and the incidence of postoperative pulmonary complications was reduced (OR=0.32, 95%CI: 0.22-0.49, P< 0.001) . Conclusions Preoperative pulmonary rehabilitation can improve lung function of patients with lung cancer, shorten the time of postoperative hospitalization and reduce the incidence of postoperative pulmonary complications. Key words: Meta-analysis; Lung neoplasms; Preoperative pulmonary rehabilitation

Effectiveness of perioperative pulmonary rehabilitation in thoracic surgery.

Functional condition is crucial for operability of patients with lung cancer and/or chronic respiratory diseases. The aim of the study was to measure changes of functional and quality of life parameters in terms of the effectiveness of perioperative pulmonary rehabilitation (PR). A total of 208 COPD patients (age: 63±9 years, man/woman: 114/94, FEV1: 62±14%pred) participated in a perioperative PR program. The indication was primary lung cancer in 72% of the patients. The 68 patients participated in preoperative (PRE) rehabilitation, 72 in a pre- and postoperative rehabilitation (PPO) and 68 patients only in postoperative rehabilitation (POS). PR program included respiratory training techniques, individualized training and smoking cessation. Lung function tests, 6 minutes walking distance (6MWD) were measured before and after the rehabilitation. Quality of life tests [COPD Assessment Test (CAT) and Modified Medical Research Council Dyspnoea Scale (mMRC)] were evaluated as well. There was a significant improvement in FEV1 (PRE: 64±16 vs. 67±16%pred; PPO: 60±13 vs. 66±13%pred before the operation, 48±13 vs. 52±13%pred after the operation; POS: 56±16 vs. 61±14%pred, P<0.05) and 6MWD (PRE: 403±87 vs. 452±86 m; PPO: 388±86 vs. 439±83 m before, 337±111 vs. 397±105 m after the operation; POS: 362±89 vs. 434±94 m, P<0 0001). Significant improvement was detected in FVC, grip strength, mMRC and CAT questionnaires as an effectiveness of PR, also. Average intensive care duration was 3.8±5.2 days with vs. 3.1±3.6 without preoperative PR. Improvements in exercise capacity and quality of life were seen following PR both before and after thoracic surgery.

Association between perioperative pulmonary rehabilitation and postoperative pneumonia in lung cancer resection patients

Association between perioperative pulmonary rehabilitation and postoperative pneumonia in lung cancer resection patients

A randomized multicenter Phase II study of perioperative tiotropium intervention in gastric cancer patients with chronic obstructive pulmonary disease.

BackgroundTiotropium, a long-acting inhaled anticholinergic drug, has been widely used in the treatment of chronic obstructive pulmonary disease (COPD). However, the issue of whether perioperative tiotropium improves postoperative outcomes for gastric cancer patients with COPD remains unclear. Thus, the aim of this study was to determine the efficacy of perioperative tiotropium intervention for gastric cancer patients with COPD.Patients and methodsEighty-four gastric cancer patients with mild-to-moderate COPD were randomly assigned to receive perioperative pulmonary rehabilitation alone (control group) or pulmonary rehabilitation with 18 µg of tiotropium once daily (tiotropium group). The patients in the tiotropium group received tiotropium for more than 1 week before surgery and for 2 weeks after surgery. Spirometry was performed prior to group assignment and at 2 weeks after surgery. Postoperative complications, forced expiratory volume in 1 second, forced vital capacity, and the ratio of forced expiratory volume in second to forced vital capacity (%) were compared between the two groups.ResultsThere were no significant differences between the two groups in terms of age, body mass index, smoking, gastrectomy incision, operation time, and bleeding volume (all P>0.05). Postoperative complications and pulmonary functions did not differ significantly between the control and tiotropium groups. A subgroup analysis of gastric cancer patients with moderate COPD showed that perioperative tiotropium intervention significantly decreased the rate of postoperative complications compared with the control group (P=0.046). However, even after gastrectomy, many patients with mild COPD in both the control and tiotropium groups showed improved pulmonary function.ConclusionAlthough perioperative tiotropium intervention had no significant effects in gastric cancer patients with mild COPD, it may be beneficial in those with moderate COPD. Therefore, the next prospective study should further evaluate perioperative tiotropium intervention for gastric cancer patients with moderate-to-severe COPD.

Impact of physical functions on short-term outcomes after thoracoscopic lobectomy for early-stage non-small cell lung cancer

Background:Many studies have demonstrated that thoracoscopic lobectomy is superior to open thoracotomy in terms of short-termoutcomes in patientswith early-stage non-small cell lung cancer. However, few studies have analyzed the predictor of the postoperative deteriorationof performance status or complication in patients undergoing thoracoscopic lobectomy, despite considerable research in open thoracotomy. Besides, those studies did not cover the physical functions such as a muscle strength or an exercise capacity. Purpose: The purposes of this study were to identify predictors of short-term outcomes including the postoperative deterioration of the performance status and cardiopulmonary complications and to determine whether preoperative physical function including the lower-limb muscle strength and exercise capacity is associated with the short-term outcomes. Methods: Between June 2005 and October 2012, we retrospectively reviewed 188 consecutive patients who underwent thoracoscopic lobectomy and the perioperative pulmonary rehabilitation for preoperative stage I non-small cell lung cancer. Demographic, lung and physical functions, surgical, and oncologic data were initially analyzed by using univariate analysis. Those with a P value of less than 0.2 of univariate analyses were used as independent variables in themultivariate logistic regression analyses. Pulmonary rehabilitation that consisted of postoperative early mobilization and progressive exercise training was administered during the patients’ hospitalization. Results: The incidences of postoperative deterioration of performance status and cardiopulmonary complication were 13.8% (n= 26) and 19.1% (n= 36), respectively. Multivariate analyses showed that percent of predicted diffusion capacity of the lung for carbon monoxide (<80.0%), quadriceps muscle strength (<40% of body weight), and pathologic stage (≥stage IIA) were independent risk factors for the deterioration of performance status after surgery (odds ratio, 3.44; P= 0.0146, odds ratio, 4.53; P= 0.007, odds ratio, 9.5; P< 0.001, respectively), and comorbidity of chronic obstructive pulmonary disease, six-minute walk distance (<400m), and pathologic stage (≥stage IIA) were independent risk factors for the postoperative cardiopulmonary complication (odds ratio, 5.88; P< 0.001, odds ratio, 4.04; P= 0.031, odds ratio, 4.81; P= 0.002, respectively). Conclusion(s): Not only greater pathologic stage, diffusion capacity of the lung, and chronic obstructive pulmonary disease, which were similar to those reported in previous studies, but also poor physical function was associated with worse short-term outcomes. Therefore, the evaluation of preoperative physical function may be useful as a predictor of short-term outcomes. Implications: This study suggest that the evaluation of preoperative physical function may be helpful for a risk stratification for the deterioration of performance status and the development of cardiopulmonary complication after surgery. These findings could be incorporated into a physical therapy practice in patient with lung cancer being considered for resectional surgery even by using a minimally invasive surgical approach. Further studies are warranted to determine whether a perioperative physical therapy with the aim of increasingmuscle strength and exercise capacity can improve the short-term outcomes.