Respiratory muscle training with electronic devices in the postoperative period of hepatectomy: A randomized study

doi:10.4254/wjh.v15.i5.688

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May 27, 2023 (publication date) through Oct 7, 2024

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World Journal of Hepatology

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1948-5182

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Clinical Trials Study

World J Hepatol. May 27, 2023; 15(5): 688-698
Published online May 27, 2023. doi: 10.4254/wjh.v15.i5.688

Table 1 Demographic and clinical data of the studied groups, n (%)

	Group
Variables	GTMI (n = 21)	CG (n = 20)	Total/average (n = 41)	P value
Feminine gender	7 (33.3)	7 (35.0)	14 (34.1)	0.9104²
Male gender	14 (66.7)	13 (65.0)	27 (65.9)	0.9104²
Mean age (yr) (SD)	56.7 ± 13.1	49.3 ± 16.1	53.1 ± 14.9	0.1401¹
Mean BMI (SD)	28.3 ± 4.0	26.2 ± 6.2	27.3 ± 5.2	0.1404¹

¹Based on the Mann-Whitney test.

²Based on the χ² test.

GTMI: Inspiratory muscle training group; CG: Control group; BMI: Body mass index; SD: Standard deviation.

Table 2 Diagnosis and background of the studied groups, n (%)

	Group
Variables	GTMI (n = 21)	CG (n = 20)	Total (n = 41)	P value
Diagnostics
Liver metastasis	9 (42.9)	8 (40.0)	17 (41.5)
Hepatocellular carcinoma	8 (38.1)	3 (15.0)	11 (26.8)
Hepatic nodule	3 (14.3)	4 (20.0)	7 (17.1)
Cholangiocarcinoma	1 (4.8)	4 (20.0)	5 (12.2)
Hemangioma	0 (0.0)	1 (5.0)	1 (2.4)	-
Background
Hepatic cirrhosis
No	15 (71.4)	18 (90.0)	33 (80.5)
Yes	6 (28.6)	2 (10.0)	8 (19.5)	0.2379²
Hepatitis C
No	17 (81.0)	18 (90.0)	35 (85.4)
Yes	4 (19.0)	2 (10.0)	6 (14.6)	0.6628²
Previous neoplasm
No	10 (47.6)	8 (40.0)	18 (43.9)
Yes	11 (52.4)	12 (60.0)	23 (56.1)	0.6232¹
Chemotherapy
No	12 (57.1)	13 (65.0)	25 (61.0)
Yes	9 (42.9)	7 (35.0)	16 (39.0)	0.6062¹
Smoker/former smoker
No	15 (71.4)	18 (90.0)	33 (80.5)
Yes	6 (28.6)	2 (10.0)	8 (19.5)	0.2379²

¹Based on the chi-square test.

²Based on Fisher's exact test.

GTMI: Inspiratory muscle training group; CG: Control group.

Table 3 Complications and length of hospital stay in the postoperative period, n (%)

	Group
Variables	GTMI (n = 21)	CG (n = 20)	Total (n = 41)	P value
Postoperative complications
No	15 (71.4)	13 (65.0)	28 (68.3)
Yes	6 (28.6)	7 (35.0)	13 (31.7)	0.6584²
Intraoperative bleeding (n)	2 (9.5)	0 (0.0)	2 (4.9)
TEP	0 (0.0)	1 (5.0)	1 (2.4)
Paralytic ileus	2 (9.5)	1 (5.0)	3 (7.3)
Anemia	1 (4.8)	1 (5.0)	2 (4.9)
PNM	0 (0.0)	1 (5.0)	1 (2.4)
SPO_{2 drop} < 92	0 (0.0)	2 (10.0)	2 (4.9)
ARI	1 (4.8)	0 (0.0)	1 (2.4)
Biliary fistula	0 (0.0)	1 (5.0)	1 (2.4)	-
Postoperative hospital stay (in days)
Mean (SD)	5.4 ± 2.0	7.1 ± 3.9	6.2 ± 3.2	0.0596¹

¹Based on the Mann-Whitney test.

²Based on the Chi-square test.

GTMI: Inspiratory muscle training group; CG: Control group; TEP: Pulmonary thromboembolism; PNM: Pneumonia; SpO₂: Peripheral oxygen saturation; ARI: Acute renal failure; SD: Standard deviation.

Table 4 Comparison of respiratory variables measured with the manovacuometer, ventilometer and with the Powerbreathe^®between the preoperative, the first and fifth postoperative days of the inspiratory muscle training group and control group

	GTMI (n = 21)			CG (n = 20)			P value²
Variables	Pre-op	PO first day¹	PO fifth day	Pre-op	PO first day	PO fifth day	P value²
Manovacuometer
PIM (cmH₂O)	110.9 ± 41	71.6 ± 42	115.6 ± 51	115.4 ± 73	77.9 ± 56	99.6 ± 68	0.0131
PEM (cmH₂O)	101.0 ± 28	58.1 ± 26	83.1 ± 30	103.5 ± 43	63.0 ± 37	84.8 ± 42	0.6186
Ventilometer
CV (liters/min)	2789 ± 938	1423 ± 589	1937 ± 585	2705 ± 836	1356 ± 392	1737 ± 541	0.6014
V_T (mL)	483.2 ± 273	425.2 ± 183	543.7 ± 221	473.1 ± 213	354.9 ± 161	474.2 ± 162	0.2866
VM (liters/min)	6905 ± 3449	7060 ± 2753	11012 ± 5381	7732 ± 3849	6573 ± 2746	9117 ± 3325	0.2091
Powerbreathe^®
Energy (joules)	1.24 ± 1.4	0.61 ± 1.2	0.57 ± 0.3	0.87 ± 0.2	0.30 ± 0.1	0.52 ± 0.2	0.3098
Flow (liters/min)	1.78 ± 1.0	0.86 ± 0.8	1.21 ± 0.5	1.52 ± 0.7	0.64 ± 0.3	0.93 ± 0.4	0.4224
Power (watts)	0.99 ± 1.2	0.53 ± 1.0	0.53 ± 0.2	0.67 ± 0.3	0.32 ± 0.2	0.42 ± 0.2	0.3533
Pressure (cmH₂O)	4.86 ± 2.0	4.53 ± 1.7	4.31 ± 0.2	4.32 ± 0.2	4.11 ± 0.1	4.31 ± 0.5	0.1405
Volume (liters)	1.82 ± 0.8	0.84 ± 0.5	1.15 ± 0.4	1.75 ± 0.5	0.61 ± 0.2	0.85 ± 0.2	0.0583

¹In Po1 all respiratory measurements were statistically lower (P ≤ 0.0001).

²The statistical test used was ANOVA for repeated measures with transformation by rank of the effect of the interaction between groups and times.

GTMI: Inspiratory muscle training group; PO: Post-operative; CG: Control group; Pre-op: Pre-operative; PIM: Maximum inspiratory pressure; PEM: Maximum inspiratory pressure; VC: Vital capacity; V_T: Tidal volume; VM: Minute volume.

Citation: Pereira MG, Silva AMO, Galhardo FDM, Almeida BDM, Lopes RL, Boin IFSF. Respiratory muscle training with electronic devices in the postoperative period of hepatectomy: A randomized study. World J Hepatol 2023; 15(5): 688-698
URL: https://www.wjgnet.com/1948-5182/full/v15/i5/688.htm
DOI: https://dx.doi.org/10.4254/wjh.v15.i5.688