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Mizusawa H, Higashimoto Y, Shiraishi O, Shiraishi M, Sugiya R, Noguchi M, Kanki K, Kimura T, Ishikawa A, Yasuda T. Preoperative inspiratory muscle training preserved diaphragmatic excursion after esophagectomy: a randomized-controlled trial. Esophagus 2025; 22:331-339. [PMID: 40178716 DOI: 10.1007/s10388-025-01123-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2024] [Accepted: 03/22/2025] [Indexed: 04/05/2025]
Abstract
BACKGROUND Preoperative inspiratory muscle training (IMT) enhances diaphragmatic excursion (DE) in patients with esophageal cancer; however, the postoperative effects of IMT on DE have not yet been evaluated. This study aimed to investigate the effect of preoperative IMT on perioperative diaphragmatic function as measured by DE, inspiratory muscle strength, lung function, and exercise tolerance. METHODS This was a parallel, randomized-controlled trial. Patients with thoracic or abdominal esophageal cancer scheduled for esophagectomy were randomized into either the incentive spirometry (IS) or IMT group. Each intervention was performed during preoperative neoadjuvant chemotherapy (NAC). The primary outcome was the DE, and the secondary outcomes were maximal inspiratory pressure (MIP), lung function, and exercise tolerance, which were measured before and 1-3 months after esophagectomy. RESULTS Thirty-two patients were included in the analysis. The DE in the IMT group (n = 15) increased from baseline to pre-operation, and the rate of change was significantly greater than that in the IS group (n = 17). Although the DE and MIP decreased in both groups after esophagectomy, the decline in the DE after esophagectomy was significantly lower in the IMT group than that in the IS group (p < 0.05). Furthermore, significant differences in DE persisted at least until 3 months post-esophagectomy, whereas MIP did not differ significantly at any time point. Pulmonary function and exercise tolerance were not significantly different between the two groups. CONCLUSIONS The IMT before esophagectomy enhanced diaphragmatic function, which was preserved for more than 3 months after esophagectomy.
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Affiliation(s)
- Hiroki Mizusawa
- Faculty of Medicine, Department of Rehabilitation Medicine, Kindai University, 377-2, Ohno-higashi, Osakasayama, 589-5811, Japan.
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe, Japan.
| | - Yuji Higashimoto
- Faculty of Medicine, Department of Rehabilitation Medicine, Kindai University, 377-2, Ohno-higashi, Osakasayama, 589-5811, Japan
- Department of Respiratory Medicine and Allergology, School of Medicine, Kindai University, Osaka, Japan
| | - Osamu Shiraishi
- Faculty of Medicine, Department of Surgery, Kindai University, Osaka, Japan
| | - Masashi Shiraishi
- Faculty of Medicine, Department of Rehabilitation Medicine, Kindai University, 377-2, Ohno-higashi, Osakasayama, 589-5811, Japan
| | - Ryuji Sugiya
- Faculty of Medicine, Department of Rehabilitation Medicine, Kindai University, 377-2, Ohno-higashi, Osakasayama, 589-5811, Japan
| | - Masaya Noguchi
- Faculty of Medicine, Department of Rehabilitation Medicine, Kindai University, 377-2, Ohno-higashi, Osakasayama, 589-5811, Japan
| | - Kengo Kanki
- Faculty of Medicine, Department of Rehabilitation Medicine, Kindai University, 377-2, Ohno-higashi, Osakasayama, 589-5811, Japan
| | - Tamotsu Kimura
- Faculty of Medicine, Department of Rehabilitation Medicine, Kindai University, 377-2, Ohno-higashi, Osakasayama, 589-5811, Japan
| | - Akira Ishikawa
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe, Japan
| | - Takushi Yasuda
- Faculty of Medicine, Department of Surgery, Kindai University, Osaka, Japan
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Aisiaiti A, Ajiaikebaier A, Maimaitiming A, Geng Q, He B, Sun J, Zhang B. Association of Diaphragmatic Mobility and Thickening Fraction with Postoperative Pulmonary Complications in Patients Undergoing Thoracic Surgery and Their Application in Prediction. Ther Clin Risk Manag 2025; 21:501-509. [PMID: 40297062 PMCID: PMC12035405 DOI: 10.2147/tcrm.s519646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2025] [Accepted: 04/14/2025] [Indexed: 04/30/2025] Open
Abstract
Purpose To investigate the association of diaphragmatic mobility and thickening fraction with postoperative pulmonary complications (PPCs) in patients undergoing thoracic surgery and evaluate their values in predicting PPCs. Patients and Methods One hundred and nine consecutive patients undergoing thoracic surgery were prospectively enrolled. All patients underwent ultrasound measurements to obtain diaphragmatic mobility and thickening fraction. PPCs were systematically monitored and recorded from postoperative day 1 to 7. The binary logistic regression model was used to perform multivariate analysis, and the receiver operating characteristic (ROC) curve was used to evaluate predictive values. Results PPCs occurred in 46 patients (42.2%). Multivariate analysis identified age, smoking, surgical sites, and mean diaphragmatic mobility and thickening fraction of operated side and nonoperated side as independent risk factors for PPCs. ROC curves revealed that the AUC of mean diaphragmatic mobility and thickening fraction for predicting PPCs in patients undergoing thoracic surgery was 0.722 [standard error (SE): 0.050, 95% confidence interval (CI): 0.623~0.821, P<0.001] and 0.757 (SE: 0.050, 95% CI: 0.659~0.855, P<0.001), respectively. The predictive model integrating age, smoking and surgical sites yielded an AUC of 0.810 (SE: 0.041, 95% CI: 0.728~0.891, P<0.001), while the predictive model integrating age, smoking, surgical sites and mean diaphragmatic mobility or thickening fraction yielded an AUC of 0.849 (SE: 0.037, 95% CI: 0.777~0.922, P<0.001) and 0.881 (SE: 0.033, 95% CI: 0.815~0.946, P<0.001), respectively. Conclusion Both diaphragmatic mobility and thickening fraction showed independent associations with PPCs following thoracic surgery, demonstrating moderate predictive values. The predictive models integrating age, smoking, surgical sites and diaphragmatic mobility or thickening fraction yielded high predictive values, suggesting significant clinical utility for risk stratification. Diaphragmatic mobility and thickening fraction offer a bedside, noninvasive, and cost-effective alternative for perioperative PPC prediction, particularly in resource-limited settings.
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Affiliation(s)
- Abudushalamu Aisiaiti
- Center for Anesthesia and Perioperative Medicine, Xinjiang Medical University Affiliated Tumor Hospital, Urumqi, 830011, People’s Republic of China
| | - Aiwuzaili Ajiaikebaier
- Center for Anesthesia and Perioperative Medicine, Xinjiang Medical University Affiliated Tumor Hospital, Urumqi, 830011, People’s Republic of China
| | - Aini Maimaitiming
- Center for Anesthesia and Perioperative Medicine, Xinjiang Medical University Affiliated Tumor Hospital, Urumqi, 830011, People’s Republic of China
| | - Qiang Geng
- Center for Anesthesia and Perioperative Medicine, Xinjiang Medical University Affiliated Tumor Hospital, Urumqi, 830011, People’s Republic of China
| | - Bichen He
- Center for Anesthesia and Perioperative Medicine, Xinjiang Medical University Affiliated Tumor Hospital, Urumqi, 830011, People’s Republic of China
| | - Jinhui Sun
- Center for Anesthesia and Perioperative Medicine, Xinjiang Medical University Affiliated Tumor Hospital, Urumqi, 830011, People’s Republic of China
| | - Bing Zhang
- Center for Anesthesia and Perioperative Medicine, Xinjiang Medical University Affiliated Tumor Hospital, Urumqi, 830011, People’s Republic of China
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Alzahrani M, Mehta R, Kadiri S, Algaeed S, Osman A, Alsanad M, Duda J, Gao F, Naidu B. Effect of pulmonary rehabilitation on lung cancer surgery outcomes: a matched-case analysis. Perioper Med (Lond) 2025; 14:35. [PMID: 40133938 PMCID: PMC11934484 DOI: 10.1186/s13741-025-00510-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2024] [Accepted: 02/23/2025] [Indexed: 03/27/2025] Open
Abstract
Pulmonary rehabilitation programs for COPD patients are extensively accessible throughout the UK and have demonstrated efficacy in enhancing outcomes, including recovery from exacerbations. Numerous lung cancer surgery patients possess COPD, and the surgery may be regarded as a definitive aggravation of COPD. It is ambiguous in practical application whether referral to pulmonary rehabilitation programs enhances surgical and patient-reported results. We want to address this topic by conducting a propensity-score analysis (PSA) of participants in an enriched cohort trial. Methods An enriched cohort research was conducted, providing rehabilitation both pre- and post-surgery pragmatically through local pulmonary rehabilitation providers for patients undergoing lung cancer resection, and compared to a contemporaneous control group receiving standard treatment. The study enrolled 873 participants (pulmonary rehabilitation (PR) n = 135, non-intervention or control (NG) n = 738). Regression analyses for exposed and unexposed matching, effect estimation, and standard error estimations were conducted.Results A total of 114 participants were matched PR (n = 57) and NG (n = 57). The multivariate-linear regression indicated a reduction in length of stay (LOS) of 0.2 days of LOS compared to the usual care group (EE = - 0.20), and that reduction could potentially go up to 1.8 days (95% CI = - 1.8-1.6). The multivariate log-binomial regression revealed that PR had a reduction of 60% postoperative pulmonary complications (PPC) rate (EE = - 0.60, 95% CI = - 1.8-0.5). Lastly, the multivariate-linear regression showed an improvement in quality of life 6 weeks and 6 months after surgery (QoL) in patients in PR, especially in the physical functioning score in which an improvement of 6.6% was noted for the PR group compared to the NG group following surgery (EE = 6.6). Conclusion Participation in "real world" pulmonary rehabilitation prior to and following surgery seems to yield improved patient and clinical results post-lung cancer surgery. Nonetheless, prompt access to pulmonary rehabilitation may be a significant challenge following COVID.
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Affiliation(s)
- Matar Alzahrani
- College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
- Institution of Inflammation and Aging, University of Birmingham, Birmingham, UK.
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
| | - Rajnikant Mehta
- Wolfson Institute of Population Health, University of London, Mile End, Queen Mary, UK
| | - Salma Kadiri
- Thoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Aya Osman
- Thoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mohammed Alsanad
- College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Joan Duda
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Fang Gao
- Institution of Inflammation and Aging, University of Birmingham, Birmingham, UK
| | - Babu Naidu
- Institution of Inflammation and Aging, University of Birmingham, Birmingham, UK
- Thoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Li M, Fu G, Mo W, Yan Y. Summary of best evidence for prevention of postoperative pulmonary complications after surgery for patients undergoing gastric cancer operations. Front Oncol 2025; 15:1515502. [PMID: 40110194 PMCID: PMC11919682 DOI: 10.3389/fonc.2025.1515502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2024] [Accepted: 02/17/2025] [Indexed: 03/22/2025] Open
Abstract
Background Postoperative pulmonary complications in gastric cancer surgery significantly impact patient recovery and prognosis. These complications, including infections, can increase hospital stays and costs, and even lead to death. Numerous risk factors are involved, such as age, smoking history, and lung function. Although preventive measures exist, a unified and effective strategy is lacking. Therefore, researching and implementing effective prevention measures is crucial for improving patients' postoperative quality of life and survival rates. Aim To collate and summarize the best available evidence for the prevention of pulmonary complications in patients undergoing gastric cancer surgery, thereby providing a reference for the clinical development of relevant intervention strategies. Methods A literature search was conducted in databases including BMJ Best Practice, UpToDate, JBI, Cochrane Library, PubMed, Embase, the Ontario Nurses Registration Network, the U.S. National Clinical Practice Guidelines, and MedLine, for documents related to the prevention of pulmonary complications in gastric cancer surgery patients. The search period extended from the inception of these databases to July 25, 2024. The quality of the literature was evaluated according to the standards of the Joanna Briggs Institute (JBI) Evidence-Based Health Care Center, and evidence was extracted from the included documents. Results A total of 27 documents were ultimately included. The extracted content encompassed three areas: preoperative assessment, risk prevention and intervention measures, totaling 31 best evidences across five categories. The findings of our study underscore the significance of comprehensive preoperative assessments, such as the ARISCAT index for pulmonary risk evaluation, and stress the importance of preoperative interventions like inspiratory muscle training, smoking cessation, and oral care in mitigating postoperative pulmonary complications (PPCs) following gastric cancer surgery. We also advocate for the adoption of protective lung ventilation strategies during surgery and continuous pulse oximetry monitoring postoperatively, along with targeted treatments for specific complications. Conclusion The best evidence extracted for the prevention of complications in gastric cancer surgery patients serves as a basis for evidence-based practice for the prevention of pulmonary complications in this patient group. Further research topics on pulmonary complications of gastric cancer, we recommend further optimization of preoperative assessment tools, investigation into the efficacy of smoking cessation programs, comparative studies on intraoperative ventilation strategies, development of postoperative rehabilitation programs, and research into culturally and resource-sensitive interventions to broaden the global applicability of these practices.
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Affiliation(s)
- Mengnan Li
- School of Nursing, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Guang Fu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of University of South China, Hengyang, China
| | - Wenjuan Mo
- School of Nursing, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Yuanyuan Yan
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of University of South China, Hengyang, China
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Li S, Fang M, Yin R, Wang Y, Chen R, Wang C, Li K, Shi W, Tang ST. Enhanced recovery after minimally invasive pneumonectomies in children. Pediatr Surg Int 2025; 41:81. [PMID: 39955421 DOI: 10.1007/s00383-025-05977-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2025] [Indexed: 02/17/2025]
Abstract
PURPOSE The study aimed to explore the feasibility and effect of pulmonary rehabilitation (PR) in the recovery of children who underwent thoracoscopic pulmonary resection. METHODS From January 2015 to December 2021, consecutive patients who underwent thoracoscopic pulmonary resection were divided into group A and group B. All of them were treated with the same perioperative protocols except for group A with perioperative lung rehabilitation management, while group B was not. Demographics, operative data, postoperative complications and clinical outcomes were compared between these two groups. RESULTS Sixty eight cases enrolled with 33 in group A and 35 in group B. Demographic data was comparable between the two groups, as well as the dose of tramadol and diclofenac sodium. Few patients in group A had temperature higher than 38℃ in the first 3 days after the surgery. The mean time of the first ambulation after the operation was shorter in group A than that in group B. The drainage time and the postoperative hospital stay were similar. No interventions needed for complications. CONCLUSION The application of perioperative PR in children who underwent thoracoscopic pulmonary resection is safe and feasible.
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Affiliation(s)
- Shuai Li
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Mijing Fang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Rui Yin
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Yali Wang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Rong Chen
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Chen Wang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Kang Li
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Wenjia Shi
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.
| | - Shao-Tao Tang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.
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Prakash Bhandoria G, Guru A, Pawar A, Bhatt A, Kumar N, Kumar R, Patel S, Lal Solanki S, Sukumar V, Rajagopal AK, Somashekhar S. INDEPSO-ISPSM consensus on peritoneal malignancies - Enhanced recovery after surgery in cytoreductive surgery (CRS) with/without hyperthermic intraperitoneal chemotherapy (HIPEC). Gynecol Oncol Rep 2025; 57:101662. [PMID: 39811827 PMCID: PMC11732209 DOI: 10.1016/j.gore.2024.101662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Revised: 10/28/2024] [Accepted: 12/11/2024] [Indexed: 01/03/2025] Open
Abstract
Background The role of enhanced recovery after surgery (ERAS) in cytoreductive surgery and/or Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is evolving, with promising results that improve patient outcomes. This consensus exercise was carried out to address and standardize components of the ERAS protocol pertinent to the Indian context. Method The modified Delphi method was employed with two rounds of voting. All fifty invited specialists agreed to vote. There were 30 questions addressing the key elements of ERAS protocols. They were broadly distributed across four sections: Prehabilitation, Preoperative, Intraoperative, and Postoperative elements. A consensus was achieved if any one option received > 70 % votes (strong consensus > 90 %). If consensus was not achieved in round 1, the question was moved to round 2. Results After rounds I and II, 48/50 (95.8%) of invited panelists voted for the questions. The highest rate of 'skipped question' was 6% in both rounds. A consensus was obtained for 28/30 (93.33%) questions, and strong consensus was obtained for 5/30 (16.6%) questions. No consensus was obtained for two questions. Some of the panelists' recommendations contradicted the standard ERAS guidelines, such as using intraperitoneal drains in all patients and mechanical bowel preparation for left-sided colonic or rectal resections. Conclusion Despite some limitations, this consensus exercise represents a significant step toward advancement and pioneering efforts to improve patient outcomes by implementing and standardizing ERAS protocols in CRS and/or HIPEC tailored for India.
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Affiliation(s)
| | - Arvind Guru
- Dept of Surgical Oncology, Homi Babha Cancer Hospital and Research Centre (HBCHRC), New Chandigarh, Punjab, India
| | - Ajinkya Pawar
- Dept of Surgical Oncology, The Gujarat Cancer & Research Institute, Ahmedabad, Gujarat, India
| | - Aditi Bhatt
- Dept of Surgical Oncology, Shalby Cancer and Research Institute, Ahmedabad, India
| | - Neha Kumar
- Dept of Gynaecologic Oncology, Amrita Hospital, Faridabad, India
| | - Rohit Kumar
- Dept of Surgical Oncology, Aster International Institute of Oncology, Bangalore, India
| | - Swapnil Patel
- Dept of Surgical Oncology, Upkar Hospital and Cancer Institute, Varanasi, India
| | | | - Vivek Sukumar
- Dept of Surgical Oncology, Specialty Surgical Oncology, Mumbai, India
| | - Ashwin K. Rajagopal
- Dept of Surgical Oncology, Aster International Institute of Oncology, Bangalore, India
| | - S.P. Somashekhar
- Dept of Surgical Oncology, Aster International Institute of Oncology, Bangalore, India
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Matsui R, Yonezu K, Rifu K, Watanabe J, Inaki N, Fukunaga T, Nunobe S. Impact of sarcopenic obesity on postoperative outcomes in patients with oesophago-gastric cancer: A systematic review and meta-analysis. World J Surg 2025; 49:459-471. [PMID: 39725406 DOI: 10.1002/wjs.12451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2024] [Accepted: 11/23/2024] [Indexed: 12/28/2024]
Abstract
BACKGROUND We elucidated the influence of sarcopenic obesity on postoperative outcomes in patients with oesophago-gastric cancer. METHODS We conducted a systematic search on MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, the World Health Organization International Clinical Trials Platform Search Portal, and ClinicalTrials.gov to identify observational studies published from their inception to September 26, 2024. Studies involving patients who underwent radical resection for oesophago-gastric cancer and were evaluated for visceral fat mass and skeletal muscle mass through body composition were included in our analysis. The primary outcomes assessed were overall survival (OS) and postoperative complications. This protocol was registered in PROSPERO (CRD42023418403). RESULTS Ultimately, 13 studies (involving 4912 patients) were included in our qualitative and quantitative analyses. Among these studies, three were prospective cohort studies, while the remaining 10 were retrospective cohort studies. Twelve studies specifically investigated gastric cancer, while one focused on esophageal cancer. The prevalence of sarcopenic obesity ranged from 5.7% to 28.7%. Compared to the absence of sarcopenic obesity, its presence worsens OS (hazard ratio: 1.52, 95% confidence interval: 1.08-2.15, heterogeneity (I2) = 66%, certainty of the evidence: low) and increases the risk of postoperative complications (relative risk ratio: 1.88, 95% CI: 1.29-2.73, I2 = 77%, certainty of the evidence: moderate). The risk of bias in each study was deemed moderate to high. CONCLUSIONS Sarcopenic obesity worsens OS and increases the risk of postoperative complications in patients with oesophago-gastric cancer undergoing radical resection.
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Affiliation(s)
- Ryota Matsui
- Department of Gastroenterological Surgery, Cancer Institute Ariake Hospital, Tokyo, Japan
- Department of Upper Gastrointesitinal Surgery, Juntendo University Hospital, Tokyo, Japan
- Department of Gastrointestinal Surgery/Breast Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Keisuke Yonezu
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, Japan
| | - Kazuma Rifu
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke City, Tochigi, Japan
| | - Jun Watanabe
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke City, Tochigi, Japan
- Center for Community Medicine, Jichi Medical University, Shimotsuke City, Tochigi, Japan
| | - Noriyuki Inaki
- Department of Gastrointestinal Surgery/Breast Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Tetsu Fukunaga
- Department of Upper Gastrointesitinal Surgery, Juntendo University Hospital, Tokyo, Japan
| | - Souya Nunobe
- Department of Gastroenterological Surgery, Cancer Institute Ariake Hospital, Tokyo, Japan
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Yu P, Luo Z, Wang Y, Lin S, Qin D, Jones AY, He J. Preoperative inspiratory muscle training improves lung function prior to elective heart valve surgery and reduces postoperative lung function impairment and pulmonary complications: a randomised trial. J Physiother 2025; 71:27-34. [PMID: 39675947 DOI: 10.1016/j.jphys.2024.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2024] [Revised: 11/29/2024] [Accepted: 12/03/2024] [Indexed: 12/17/2024] Open
Abstract
QUESTION What is the effect of 3 days of preoperative inspiratory muscle training (IMT) on lung function prior to heart valve surgery and on postoperative lung function and pulmonary complications compared with sham and no IMT? DESIGN A three-arm, multicentre, randomised controlled trial with concealed allocation, intention-to-treat analysis and blinded assessment of some outcomes. PARTICIPANTS This study included 228 adults scheduled for heart valve surgery. INTERVENTIONS The IMT group received 3 days of IMT at 30% maximal inspiratory pressure, the sham IMT group received the same but at 10% maximal inspiratory pressure and the control group received no IMT. OUTCOME MEASURES Spirometric measures, maximal inspiratory pressure and maximum voluntary ventilation were measured at hospital admission, the day before surgery and at discharge. The incidence of postoperative pulmonary complications (primary outcome) and adverse events were recorded. RESULTS A total of 215 participants completed surgery as planned and all participants were followed up until discharge. Spirometric measures, maximal inspiratory pressure and maximum voluntary ventilation improved in all groups between admission and the day before surgery, but more so in the IMT group. At discharge, these measures had deteriorated in all groups, but less so in the IMT group. Preoperative IMT reduced the total number of participants experiencing a pulmonary complication in the IMT group compared with the sham IMT group (ARR -0.18, 95% CI -0.33 to -0.03) and compared with the control group (ARR -0.21, 95% CI -0.35 to -0.05). Very few adverse events occurred in all three groups. CONCLUSIONS Preoperative IMT improved lung function prior to surgery and at hospital discharge and reduced postoperative pulmonary complications in adults undergoing elective heart valve surgery. REGISTRATION ChiCTR2100054869.
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Affiliation(s)
- Pengming Yu
- Rehabilitation Medicine Centre, West China Hospital, Sichuan University, Sichuan, China
| | - Zeruxin Luo
- Rehabilitation Medicine Centre, West China Hospital, Sichuan University, Sichuan, China
| | - Yuqiang Wang
- Cardiovascular Surgery Research Laboratory, West China Hospital, Sichuan University, China
| | - Song Lin
- Department of Rehabilitation, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Deyu Qin
- Department of Rehabilitation Medicine, Tianjin Chest Hospital, Tianjin, China
| | - Alice Ym Jones
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Jiayuan He
- National Clinical Research Centre for Geriatrics, West China Hospital, Sichuan University, Chengdu, China; Med-X Centre for Manufacturing, Sichuan University, Chengdu, China.
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Lee HJ, Lee HW. Comprehensive Strategies for Preoperative Pulmonary Risk Evaluation and Management. Tuberc Respir Dis (Seoul) 2025; 88:90-108. [PMID: 39474732 PMCID: PMC11704732 DOI: 10.4046/trd.2024.0118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Revised: 10/10/2024] [Accepted: 10/28/2024] [Indexed: 01/07/2025] Open
Abstract
Postoperative pulmonary complications (PPCs) significantly increase morbidity and mortality in surgical patients, particularly those with pulmonary conditions. PPC incidence varies widely, influenced by factors such as surgery type, patient age, smoking status, and comorbid conditions, including chronic obstructive pulmonary disease (COPD) and congestive heart failure. While preoperative pulmonary function tests and chest radiographs are crucial for lung resection surgery, their use should be judiciously tailored to individual risk profiles. Effective risk stratification models, such as the American Society of Anesthesiologists classification, Arozullah respiratory failure index, Gupta Calculators, and Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) model, play a key role in predicting PPCs. Key strategies to diminish PPCs include preoperative optimization of respiratory conditions, smoking cessation, and respiratory rehabilitation. In patients with COPD and asthma, it is crucial to maintain optimal disease control through inhaled therapies, systemic corticosteroids, and tailored preoperative respiratory exercises. Anemia and hypoalbuminemia are significant predictors of PPCs and require meticulous management. The choice and duration of anesthesia also notably influence PPC risk, with regional anesthesia being preferable to general anesthesia when possible. Comprehensive preoperative evaluations and tailored interventions are essential for enhancing surgical outcomes and reducing PPC incidence. Additional studies involving domestic patients are necessary to refine national guidelines for managing those at risk of PPCs.
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Affiliation(s)
- Hyo Jin Lee
- Division of Respiratory and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyun Woo Lee
- Division of Respiratory and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
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Stiger RJ, Williams MA, Gustafson OD, Woods A, Collett J. The effectiveness of prehabilitation interventions on biopsychosocial and service outcomes pre and post upper gastrointestinal surgery: a systematic review. Disabil Rehabil 2024; 46:5676-5699. [PMID: 38323587 DOI: 10.1080/09638288.2024.2310765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/12/2024] [Accepted: 01/19/2024] [Indexed: 02/08/2024]
Abstract
PURPOSE This review synthesised the evidence for the effect of prehabilitation interventions on biopsychosocial and service outcomes. MATERIALS AND METHODS A systematic review was conducted. 10 databases were searched to December 2023. Prospective experimental studies exploring prehabilitation interventions in adults undergoing upper gastrointestinal surgery were included. Prehabilitation was any preoperative intervention to improve physical or psychological outcomes. Included studies required a comparator group or alternative preoperative intervention as well as baseline, presurgical and postoperative assessment points. Study quality was assessed using the Cochrane risk of bias tool (v.2). Data synthesis was narrative (SWiM guidance). RESULTS 6028 studies were screened, with 25 studies included. Prehabilitation interventions were: inspiratory muscle training (five studies n = 450); exercise (nine studies n = 683); psychological (one study n = 400); and nutritional (ten studies n = 487). High quality studies showed preoperative improvements in impairments directly targeted by the interventions. Generally, these did not translate into functional or postoperative improvements, but multimodal interventions were more promising. CONCLUSION Current evidence supports prehabilitation as safe to preserve or improve preoperative function. Heterogeneity in outcomes and variable study quality means definitive conclusions regarding interventions are not yet possible, limiting implementation. Agreement of clinical outcomes and cost effectiveness evaluation is required.
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Affiliation(s)
- Robyn J Stiger
- Centre for Movement, Occupational and Rehabilitation Sciences, Oxford Brookes University, Oxford, UK
| | - Mark A Williams
- Centre for Movement, Occupational and Rehabilitation Sciences, Oxford Brookes University, Oxford, UK
- Oxford Allied Health Professions Research and innovations Unit (AHPRU), Oxford University Hospitals NHS Foundation Trust, UK
| | - Owen D Gustafson
- Centre for Movement, Occupational and Rehabilitation Sciences, Oxford Brookes University, Oxford, UK
- Oxford Allied Health Professions Research and innovations Unit (AHPRU), Oxford University Hospitals NHS Foundation Trust, UK
| | | | - Johnny Collett
- Centre for Movement, Occupational and Rehabilitation Sciences, Oxford Brookes University, Oxford, UK
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McIsaac DI, Tandon P, Kidd G, Branje K, Hladkowicz E, Hallet J, Wijeysundera DN, Lee S, McNeely ML, Taljaard M, Gillis C. STRIVE pilot trial: a protocol for a multicentre pragmatic internal pilot randomised controlled trial of Structured TRaining to Improve fitness in a Virtual Environment (STRIVE) before surgery. BMJ Open 2024; 14:e093710. [PMID: 39510784 PMCID: PMC11552010 DOI: 10.1136/bmjopen-2024-093710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Accepted: 10/24/2024] [Indexed: 11/15/2024] Open
Abstract
INTRODUCTION Home-based, virtually-supported care models may represent the most efficient and scalable approach to delivering prehabilitation services. However, virtual approaches to prehabilitation are understudied. This manuscript describes the protocol for an internal pilot randomised controlled trial of a virtually-delivered, multimodal prehabilitation intervention. METHODS AND ANALYSIS We will conduct a pragmatic, individual patient, internal pilot randomised controlled trial of home-based, virtually supported, multimodal prehabilitation compared with standard perioperative care in adults undergoing elective, inpatient thoracic, abdominal, pelvic and vascular surgery at five Canadian hospitals. Participants will be partially blinded; clinicians and outcome assessors will be fully blinded. The intervention consists of 3-12 weeks of a home-based, multimodal (exercise, nutrition and psychosocial support) prehabilitation programme supported through an online platform. The primary feasibility outcomes and their progression targets are (1) monthly recruitment of>6 participants at each centre, (2) intervention adherence of>75%, (3) retention of>90% of participants at the patient-reported primary outcome point of 30-days after surgery and (4) elicitation of patient, clinician and researcher-identified barriers to our pragmatic trial. A sample size of 144 participants will be adequate to estimate recruitment, adherence and retention rates with acceptable precision. All participants will be followed to either death or up to 1 year. As an internal pilot, if no substantive changes to the trial or intervention design are required, pilot participant outcome data will migrate, unanalysed by allocation, to the future full-scale trial. ETHICS AND DISSEMINATION Ethical approval has been granted by Clinical Trials Ontario (Project ID: 4479) and our ethics review board (Protocol Approval #20230399-01T). Results will be disseminated through presentations at scientific conferences, peer-reviewed publications, partner organisations and engagement of social and traditional media. TRIAL REGISTRATION NUMBER ClinicalTrials.gov identifier NCT06042491. Protocol, V.1.2, dated 6 June 2024.
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Affiliation(s)
- Daniel I McIsaac
- Anaesthesiology and Pain Medicine, Ottawa Hospital Research Institute Clinical Epidemiology Programme, Ottawa, Ontario, Canada
| | - Puneeta Tandon
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Gurlavine Kidd
- Patient Partner, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Karina Branje
- Department of Anaesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Emily Hladkowicz
- Departments of Anaesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Julie Hallet
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Susan Lee
- Department of Anesthesiology, Pharmacology, and Therapeutics, UBC Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Margaret L McNeely
- Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
- Supportive Care, Cancer Care Alberta, Edmonton, Alberta, Canada
| | - Monica Taljaard
- Clinical Epidemiology Programme, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Chelsia Gillis
- School of Human Nutrition, McGill University, Montreal, Québec, Canada
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Kendall F, Silva G, Drummond M, Viana P, Eusébio E, Pinho P, Oliveira J, Bastos PT. Predictors of prolonged hospital stay in patients undergoing lung resection. Disabil Rehabil 2024; 46:5220-5226. [PMID: 38166526 DOI: 10.1080/09638288.2023.2297936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 12/11/2023] [Accepted: 12/16/2023] [Indexed: 01/04/2024]
Abstract
PURPOSE To identify potential predictors of prolonged length of hospital stay in patients submitted to lung resection surgery. MATERIALS AND METHODS This is a cohort study, carried out in 105 patients with lung cancer, submitted to posterolateral thoracotomy pulmonary resection. Data collection included preoperative assessment of demographic, clinical, pulmonary function, respiratory muscle function, physical fitness, and behavioral habits. After surgery, length of hospital stay was documented, and the sample was divided into two groups according to the length of hospital stay (LOS): the normal hospital stay group (NLOS) until 8 days, and the prolonged hospital stay group (PLOS) with more than 8 days of hospital stay. Multiple linear regressions were performed between length of hospital stay and the studied variables, for the total sample and, specifically, for the PLOS group. RESULTS The multiple linear regression for the total sample, the most explanatory power variables were TLC, MIP, PEF, and BMI. When considering only the PLOS, the variables that mostly explained were the MIP%, MEP and TLC%. CONCLUSION Besides the classic outcomes used to calculate surgical risk, the body mass index, respiratory muscle strength, peak expiratory flow, and total lung capacity are predictors of the variation on length of hospital stay in patients submitted to lung resection.
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Affiliation(s)
- Filipa Kendall
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), University of Porto, Porto, Portugal
- Department of Cardiothoracic Surgery, Centro Hospitalar São João, Porto, Portugal
- CESPU, Polytechnic Health Institute of the North, Gandra (PRD), Portugal
| | - Gustavo Silva
- Research Center in Sports Sciences, Health and Human Development (CIDESD), University of Maia (UMaia), Maia, Portugal
| | - Marta Drummond
- Pulmonology Department, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Paulo Viana
- Pulmonology Department, Centro Hospitalar São João, Porto, Portugal
- Health School, Polytechnic Institute of Porto, Porto, Portugal
| | | | - Paulo Pinho
- Department of Cardiothoracic Surgery, Centro Hospitalar São João, Porto, Portugal
| | - José Oliveira
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), University of Porto, Porto, Portugal
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13
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Teng H, Tian J, Shu Q. Comprehensive pulmonary rehabilitation for a 90-year-old patient with intertrochanteric fracture complicated by chronic obstructive pulmonary disease: a case report. Physiother Theory Pract 2024; 40:2712-2718. [PMID: 37842788 DOI: 10.1080/09593985.2023.2268170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 10/04/2023] [Accepted: 10/04/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD)-induced osteoporosis, myasthenia, and disequilibrium are important risk factors for hip fracture, and decreased respiratory function after hip fracture surgery can decelerate recovery of activities of daily living (ADL) in elderly patients. CASE PRESENTATION A 90-year-old male patient underwent an open reduction and intramedullary pinning surgery for right femoral intertrochanteric fracture. After surgery, he remained confined to bed with pain and swelling in the right lower extremity. Due to his history of COPD, he had a postoperative pulmonary infection and respiratory insufficiency. INTERVENTION This patient received routine rehabilitation after surgery. However, severe respiratory symptoms prevented him from completing the rehabilitation procedure. Therefore, comprehensive pulmonary rehabilitation including airway clearance techniques, inspiratory resistance training, aerobic training, respiratory muscle training, and intermittent low-flow oxygen inhalation was carried out to enhance the recovery process. OUTCOMES After 4 weeks of treatment, the patient improved from continuous oxygen inhalation to being able to complete bed resistance training without supplemental oxygen. After 8 weeks, ADL reached independence, while lower limb muscle strength, pulmonary function parameters, fatigue index, and cough efficiency were improved as compared to test values obtained before treatment. CONCLUSION Compared with the 6-month recovery time reported in the literature for patients with hip fractures to achieve independence with basic ADLs, the recovery time of this patient was shortened to 2 months with the application of comprehensive pulmonary rehabilitation. It is feasible to carry out pulmonary rehabilitation for elderly patients after fracture surgery, but prospective clinical trials are needed to verify its efficacy.
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Affiliation(s)
| | | | - Qing Shu
- Department of Rehabilitation, Zhongnan Hospital of Wuhan University, Wuhan, China
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14
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Wang J, Li H, Yan W, Xue N, Yin J, Nawsherwan, Yin S. Prehabilitation Interventions for Cardiac Surgery to Prevent Postoperative Pulmonary Complications: Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF PUBLIC HEALTH 2024; 53:2167-2179. [PMID: 39544863 PMCID: PMC11557761 DOI: 10.18502/ijph.v53i10.16683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 06/15/2024] [Indexed: 11/17/2024]
Abstract
Background Postoperative pulmonary complications (PPCs) are associated with a higher risk of morbidity and mortality in patients undergoing cardiac surgery. We aimed to investigate the effect of preoperative interventions on PPCs and length of intensive care unit and hospital stay in patients undergoing cardiac surgery. Methods A systematic review and meta-analysis was conducted on randomized or quasi-randomized trials by searching PubMed, Medline, ISI Web of Science, Science Direct, Physiotherapy Evidence Database (PEDro), and the Cochrane Library for all available years until December 2023. Our primary outcomes were PPCs including atelectasis and Pneumonia and secondary outcomes were length of intensive care unit and hospital stay. Results Twenty-one included trials provide data on 2895 participants. The preoperative intervention of inspiratory muscle training (IMT) significantly reduced the PPCs including atelectasis (OR: 0.49, 95%CI: 0.28, 0.86) and Pneumonia (OR: 0.41, 95%CI: 0.25, 0.67) in cardiac patients compared with the control group. Preoperative exercise training intervention is significantly associated with a lower risk (OR: 0.15, 95%CI: 0.06, 0.38) of composite PPCs (i.e. atelectasis and Pneumonia) in the intervention group. Preoperative IMT significantly reduced the postoperative hospital stay by -1.57 days (95% CI: -2.33, -0.81) in the intervention group. Preoperative exercise training significantly decreased the postoperative intensive care unit stay by -2.22 hours (95% CI: -3.05, -1.38) and hospital stay by -1.82 days (95% CI: -3.38, -0.27) in the intervention group. Conclusion Preoperative intervention of IMT and exercise training significantly reduce PPCs and hospital stay in patients undergoing cardiac surgery.
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Affiliation(s)
- Junhua Wang
- Department of Cardiovascular Medicine, Taixing People’s Hospital, Taizhou, Jiangsu, China
| | - Hui Li
- Department of Medicine, Taixing People’s Hospital, Taizhou, Jiangsu, China
| | - Wenjuan Yan
- Department of Cardiovascular Medicine, Taixing People’s Hospital, Taizhou, Jiangsu, China
| | - Na Xue
- Department of Cardiovascular Medicine, Taixing People’s Hospital, Taizhou, Jiangsu, China
| | - Jin Yin
- Department of Nursing, Taixing People’s Hospital, Taizhou, Jiangsu, China
| | - Nawsherwan
- Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Sha Yin
- Department of Cardiovascular Medicine, Taixing People’s Hospital, Taizhou, Jiangsu, China
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15
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Verkoulen KCHA, Laven IEWG, Daemen JHT, Degens JHRJ, Hendriks LEL, Hulsewé KWE, Vissers YLJ, de Loos ER. The (un)lucky seven-how can we mitigate risk factors for postoperative pneumonia after lung resections? Transl Lung Cancer Res 2024; 13:1763-1767. [PMID: 39263029 PMCID: PMC11384492 DOI: 10.21037/tlcr-24-428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 07/05/2024] [Indexed: 09/13/2024]
Affiliation(s)
- Koen C H A Verkoulen
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Iris E W G Laven
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Jean H T Daemen
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | | | - Lizza E L Hendriks
- Department of Pulmonology, GROW-Research Institute for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Karel W E Hulsewé
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Yvonne L J Vissers
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Erik R de Loos
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
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16
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Asanuma K, Tsujii M, Hagi T, Nakamura T, Kataoka T, Uchiyama T, Adachi R, Sudo A. Complications of chest wall around malignant tumors: differences based on reconstruction strategy. BMC Cancer 2024; 24:964. [PMID: 39107714 PMCID: PMC11304931 DOI: 10.1186/s12885-024-12690-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 07/24/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Malignant chest wall tumors need to be excised with wide resection to ensure tumor free margins, and the reconstruction method should be selected according to the depth and dimensions of the tumor. Vascularized tissue is needed to cover the superficial soft tissue defect or bone tissue defect. This study evaluated differences in complications according to reconstruction strategy. METHODS Forty-five patients with 52 operations for resection of malignant tumors in the chest wall were retrospectively reviewed. Patients were categorized as having superficial tumors, comprising Group A with simple closure for small soft tissue defects and Group B with flap coverage for wide soft tissue defects, or deep tumors, comprising Group C with full-thickness resection with or without mesh reconstruction and Group D with full-thickness resection covered by flap with or without polymethyl methacrylate. Complications were evaluated for the 52 operations based on reconstruction strategy then risk factors for surgical and respiratory complications were elucidated. RESULTS Total local recurrence-free survival rates in 45 patients who received first operation were 83.9% at 5 years and 70.6% at 10 years. The surgical complication rate was 11.5% (6/52), occurring only in cases with deep tumors, predominantly from Group D. Operations needing chest wall reconstruction (p = 0.0016) and flap transfer (p = 0.0112) were significantly associated with the incidence of complications. Operations involving complications showed significantly larger tumors, wider areas of bony chest wall resection and greater volumes of bleeding (p < 0.005). Flap transfer was the only significant predictor identified from multivariate analysis (OR: 10.8, 95%CI: 1.05-111; p = 0.0456). The respiratory complication rate was 13.5% (7/52), occurring with superficial and deep tumors, particularly Groups B and D. Flap transfer was significantly associated with the incidence of respiratory complications (p < 0.0005). Cases in the group with respiratory complications were older, more frequently had a history of smoking, had lower FEV1.0% and had a wider area of skin resected compared to cases in the group without respiratory complications (p < 0.05). Preoperative FEV1.0% was the only significant predictor identified from multivariate analysis (OR: 0.814, 95%CI: 0.693-0.957; p = 0.0126). CONCLUSIONS Surgical complications were more frequent in Group D and after operations involving flap transfer. Severe preoperative FEV1.0% was associated with respiratory complications even in cases of superficial tumors with flap transfer.
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Affiliation(s)
- Kunihiro Asanuma
- Department of Orthopedic Surgery, Mie University School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan.
| | - Masaya Tsujii
- Department of Orthopedic Surgery, Mie University School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Tomohito Hagi
- Department of Orthopedic Surgery, Mie University School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Tomoki Nakamura
- Department of Orthopedic Surgery, Mie University School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Takeshi Kataoka
- Department of Orthopedic Surgery, Mie University School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Teruya Uchiyama
- Department of Orthopedic Surgery, Mie University School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Ryohei Adachi
- Department of Orthopedic Surgery, Mie University School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Akihiro Sudo
- Department of Orthopedic Surgery, Mie University School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
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17
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[Chinese Expert Consensus on Perioperative Pulmonary Rehabilitation Training
for Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2024; 27:495-503. [PMID: 39147703 PMCID: PMC11331257 DOI: 10.3779/j.issn.1009-3419.2024.102.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Indexed: 08/17/2024]
Abstract
Perioperative pulmonary rehabilitation may effectively reduce the incidence of postoperative pulmonary complications and improve the quality of life of lung cancer patients and its clinical application value in lung cancer patients has been widely recognized. However, there is still no international consensus or guideline for pulmonary rehabilitation regimen, lacking standardized criteria when pulmonary rehabilitation applied in perioperative clinical practice for lung cancer. The consensus provides implementation regimen and process of pulmonary rehabilitation, aiming to promote the reasonable and standardized application of perioperative pulmonary rehabilitation training in clinical practice, sequentially enable patients to maximize benefits from the rehabilitation.
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18
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Su J, Huang W, Yu P. Effect of inspiratory muscle training in esophageal cancer patients receiving esophagectomy: A meta-analysis of randomized controlled trials. PLoS One 2024; 19:e0307069. [PMID: 39012869 PMCID: PMC11251638 DOI: 10.1371/journal.pone.0307069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 06/30/2024] [Indexed: 07/18/2024] Open
Abstract
PURPOSE To identify the clinical effect of inspiratory muscle training (IMT) among esophageal cancer patients undergoing esophagectomy based on randomized controlled trials (RCTs). METHODS Several databases were searched for relevant RCTs up to August 23, 2023. Primary outcomes were respiratory muscle function, including the maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP), and pulmonary function, including the forced expiratory volume in one second % (FEV1%), forced vital capacity% (FVC%), maximal ventilator volume (MVV), FEV1/FVC% and FVC. The secondary outcomes were exercise performance, including the six-minute walk distance test (6MWT) and Borg index; mental function and quality of life, as evaluated by the Hospital Anxiety Depression Scale (HADS) and Nottingham Health Profile (NHP) score; and postoperative complications. All the statistical analyses were performed with REVMAN 5.3 software. RESULTS Eight RCTs were included in this meta-analysis, with 368 patients receiving IMT and 371 control subjects. The pooled results demonstrated that IMT could significantly enhance respiratory muscle function (MIP: MD = 7.14 cmH2O, P = 0.006; MEP: MD = 8.15 cmH2O, P<0.001) and pulmonary function (FEV1%: MD = 6.15%, P<0.001; FVC%: MD = 4.65%, P<0.001; MVV: MD = 8.66 L, P<0.001; FEV1/FVC%: MD = 5.27%, P = 0.03; FVC: MD = 0.50 L, P<0.001). Furthermore, IMT improved exercise performance (6MWT: MD = 66.99 m, P = 0.02; Borg index: MD = -1.09, P<0.001), mental function and quality of life (HADS anxiety score: MD = -2.26, P<0.001; HADS depression score: MD = -1.34, P<0.001; NHP total score: MD = -48.76, P<0.001). However, IMT did not significantly decrease the incidence of postoperative complications. CONCLUSION IMT improves clinical outcomes, such as respiratory muscle function and pulmonary function, in esophageal cancer patients receiving esophagectomy and has potential for broad applications in the clinic.
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Affiliation(s)
- Jianhua Su
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Wei Huang
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Pengming Yu
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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Amirkhosravi F, Allenson KC, Moore LW, Kolman JM, Foster M, Hsu E, Sasangohar F, Dhala A. Multimodal prehabilitation and postoperative outcomes in upper abdominal surgery: systematic review and meta-analysis. Sci Rep 2024; 14:16012. [PMID: 38992072 PMCID: PMC11239889 DOI: 10.1038/s41598-024-66633-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 07/03/2024] [Indexed: 07/13/2024] Open
Abstract
The impact of multimodal prehabilitation on postoperative complications in upper abdominal surgeries is understudied. This review analyzes randomized trials on multimodal prehabilitation with patient and hospital outcomes. MEDLINE, Embase, CINAHL, and Cochrane CENTRAL were searched for trials on prehabilitation before elective (non-emergency) abdominal surgery. Two reviewers independently screened studies, extracted data, and assessed study quality. Primary outcomes of interest were postoperative pulmonary complications (PPCs) and all-cause complications; secondary outcomes included hospital and intensive care length of stay. A meta-analysis with random-effect models was performed, and heterogeneity was evaluated with I-square and Cochran's Q test. Dichotomous variables were reported in log-odds ratio and continuous variables were presented as mean difference. Ten studies (total 1503 patients) were included. Odds of developing complications after prehabilitation were significantly lower compared to various control groups (- 0.38 [- 0.75- - 0.004], P = 0.048). Five studies described PPCs, and participants with prehabilitation had decreased odds of PPC (- 0.96 [- 1.38- - 0.54], P < 0.001). Prehabilitation did not significantly reduce length of stay, unless exercise was implemented; with exercise, hospital stay decreased significantly (- 0.91 [- 1.67- - 0.14], P = 0.02). Multimodal prehabilitation may decrease complications in upper abdominal surgery, but not necessarily length of stay; research should address heterogeneity in the literature.
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Affiliation(s)
| | | | - Linda W Moore
- Department of Surgery, Houston Methodist, Houston, TX, USA
| | - Jacob M Kolman
- Office of Faculty and Research Development, Department of Academic Affairs, Houston Methodist, Houston, TX, USA
| | - Margaret Foster
- School of Medicine, Department of Medical Education, Texas A&M University, College Station, TX, USA
| | - Enshuo Hsu
- Center for Health Data Science and Analytics, Houston Methodist, Houston, TX, USA
| | - Farzan Sasangohar
- Wm Michael Barnes '64 Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, USA
- Center for Critical Care, Houston Methodist, Houston, TX, USA
| | - Atiya Dhala
- Department of Surgery, Houston Methodist, Houston, TX, USA.
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Wang K, Zhang HT, Fan FD, Pan J, Pan T, Wang DJ. A nomogram predicting pneumonia after cardiac surgery: a retrospective modeling study. J Cardiothorac Surg 2024; 19:309. [PMID: 38822375 PMCID: PMC11140971 DOI: 10.1186/s13019-024-02797-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 05/25/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Postoperative pneumonia (POP) is the most prevalent of all nosocomial infections in patients who underwent cardiac surgery. The aim of this study was to identify independent risk factors for pneumonia after cardiac surgery, from which we constructed a nomogram for prediction. METHODS The clinical data of patients admitted to the Department of Cardiothoracic Surgery of Nanjing Drum Tower Hospital from October 2020 to September 2021 who underwent cardiac surgery were retrospectively analyzed, and the patients were divided into two groups according to whether they had POP: POP group (n=105) and non-POP group (n=1083). Preoperative, intraoperative, and postoperative indicators were collected and analyzed. Logistic regression was used to identify independent risk factors for POP in patients who underwent cardiac surgery. We constructed a nomogram based on these independent risk factors. Model discrimination was assessed via area under the receiver operating characteristic curve (AUC), and calibration was assessed via calibration plot. RESULTS A total of 105 events occurred in the 1188 cases. Age (>55 years) (OR: 1.83, P=0.0225), preoperative malnutrition (OR: 3.71, P<0.0001), diabetes mellitus(OR: 2.33, P=0.0036), CPB time (Cardiopulmonary Bypass Time) > 135 min (OR: 2.80, P<0.0001), moderate to severe ARDS (Acute Respiratory Distress Syndrome )(OR: 1.79, P=0.0148), use of ECMO or IABP or CRRT (ECMO: Extra Corporeal Membrane Oxygenation; IABP: Intra-Aortic Balloon Pump; CRRT: Continuous Renal Replacement Therapy )(OR: 2.60, P=0.0057) and MV( Mechanical Ventilation )> 20 hours (OR: 3.11, P<0.0001) were independent risk factors for POP. Based on those independent risk factors, we constructed a simple nomogram with an AUC of 0.82. Calibration plots showed good agreement between predicted probabilities and actual probabilities. CONCLUSION We constructed a facile nomogram for predicting pneumonia after cardiac surgery with good discrimination and calibration. The model has excellent clinical applicability and can be used to identify and adjust modifiable risk factors to reduce the incidence of POP as well as patient mortality.
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Affiliation(s)
- Kuo Wang
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital,Affiliated Clinical College of Xuzhou Medical University, Nanjing, 210008, Jiangsu, China
| | - Hai-Tao Zhang
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, 210008, Jiangsu, China
| | - Fu-Dong Fan
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, Jiangsu, China
| | - Jun Pan
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, Jiangsu, China
| | - Tuo Pan
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, 210008, Jiangsu, China
| | - Dong-Jin Wang
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital,Affiliated Clinical College of Xuzhou Medical University, Nanjing, 210008, Jiangsu, China.
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Furon Y, Dang Van S, Blanchard S, Saulnier P, Baufreton C. Effects of high-intensity inspiratory muscle training on systemic inflammatory response in cardiac surgery - A randomized clinical trial. Physiother Theory Pract 2024; 40:778-788. [PMID: 36637368 DOI: 10.1080/09593985.2022.2163212] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 01/14/2023]
Abstract
PURPOSE Preoperative inspiratory muscle training reduces the incidence of postoperative pulmonary complications after cardiac surgery, but training protocols vary widely in terms of intensity. Currently, the mechanisms underlying the effectiveness of this practice are not known. The purpose of the present study is to determine whether preoperative high-intensity inspiratory muscle training (HI-IMT) modulates the perioperative systemic inflammatory response in cardiac surgery patients. METHODS Participants awaiting surgical aortic valve replacement were randomized to 3 to 6 weeks preoperative home-based HI-IMT or same duration low-intensity inspiratory muscle training (LI-IMT). The primary outcome was the preoperative value of the soluble tumor necrosis factor receptor 1 (sTNFR1). Secondary outcomes assessed perioperative evolution of the cytokines: sTNFR1, Tumor necrosis factor-α, Interleukin (IL)-6, IL-8, IL10, IL1β, and their combined z-score; reflecting post-training and postoperative inflammatory response. Perioperative pulmonary function and postoperative clinical outcomes were collected. RESULTS Between February 2018 and March 30, 2019 patients were randomized, to HI-IMT or LI-IMT. There were no differences between the groups in terms of baseline characteristics. The median (IQR) training duration was 34 (28-44) days. After training, the median (IQR) predicted maximal inspiratory pressure was higher in the HI-IMT vs LI-IMT group (119 (96-142%) vs 97 (81-107%); p = .04) Levels of the sTNFR1 cytokine increased during training in the HI-IMT group, pre vs post training (Median (IQR) 1073 (920; 1219) vs 1172 (965; 1368) ng/L; p = .03). The 24-h postoperative global inflammatory score was lower in the HI-IMT than in the LI-IMT group (Median (IQR), -0.37 (-0.62, 0.03) vs -0.10 (-0.17, 0.49), p = .04). Global inflammatory scores were not different at other time points. There were no significant differences between the groups in post-operative pulmonary function and postoperative clinical outcome. CONCLUSION High intensity inspiratory muscle training shows immunomodulatory properties. These properties could explain why preoperative inspiratory muscle training can lead to lung protection after cardiac surgery.
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Affiliation(s)
- Yoakim Furon
- Department of Physical and Rehabilitation Medicine, University Hospital of Angers, Angers, France
| | - Simon Dang Van
- Department of Cardiac Surgery, University Hospital of Angers, Angers, France
| | - Simon Blanchard
- Laboratory of Immunology and Allergology, University Hospital of Angers, Angers, France
| | - Patrick Saulnier
- Research Department Unit, University Hospital of Angers, Angers, France
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22
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Asanuma K, Tsujii M, Hagi T, Nakamura T, Uchiyama T, Adachi R, Nakata K, Kataoka T, Sudo A. Pedicled flap transfer after chest wall malignant tumor resection and potential risk of postoperative respiratory problems for patients with low FEV1.0. Front Surg 2024; 11:1357265. [PMID: 38505411 PMCID: PMC10948408 DOI: 10.3389/fsurg.2024.1357265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 02/01/2024] [Indexed: 03/21/2024] Open
Abstract
Introduction Musculoskeletal transfer for chest wall tissue defects is a crucial method, and pedicled flaps around the chest wall are preferred in terms of location and simplicity of transfer. These require special care because of complications such as partial necrosis, fistula, wound dehiscence, infection, hematoma and restricted function of the arm or shoulder. However, studies of respiratory function are rare. In the present study, we investigated the complications including respiratory problems after wide resection for malignant chest wall tumors with musculoskeletal pedicle transfer. Methods A total of 13 patients (15 operations) who underwent wide resection of primary, recurrent, or metastatic malignant chest wall tumors and musculoskeletal pedicle transfer for coverage of tissue defects were enrolled in the present study. A retrospective review of all patients was performed using data collected from hospital records and follow-up information. The complications of musculoskeletal transfer after chest wall wide resection, including respiratory problems, are evaluated. Results Rib or sternal resection was performed in 12 operations, and only soft tissue resection was performed in 3 operations. Latissimus dorsi (LD) pedicle transfer was performed in 13 operations, and pectoralis major (PM) pedicle transfer was performed in 2 operations; basically, wounds were closed primarily. Surgical complications were observed following 5 of the 15 operations (33.3%). Respiratory complications were seen in 7 of the 15 operations (46.7%). Patients with respiratory complications showed significantly lower preoperative FEV1.0% values than those without respiratory complications (p = 0.0196). Skin resection area tended to be higher in the complication group than in the no complication group (p = 0.104). Discussion Pedicled myocutaneous flap transfers such as LD, PM, and rectus abdominus can be used following multiple resections. After harvesting LD or PM, the wound can be closed primarily for an 8-10-cm skin defect in patients with normal respiratory function. However, for patients with low FEV1.0%, after primary closure of LD or PM transfer for wide soft tissue defects, attention should be paid to postoperative respiratory complications.
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Affiliation(s)
- Kunihiro Asanuma
- Department of Orthopedic Surgery, Mie University School of Medicine, Tsu City, Japan
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23
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Overbeek MC, Reijneveld EA, Valkenet K, van Adrichem EJ, Dronkers JJ, Ruurda JP, Veenhof C. The Association Between Preoperative Inspiratory Muscle Training Variables and Postoperative Pulmonary Complications in Subjects With Esophageal Cancer. Respir Care 2024; 69:290-297. [PMID: 37935528 PMCID: PMC10984600 DOI: 10.4187/respcare.11199] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
BACKGROUND Preoperative inspiratory muscle training (IMT) is frequently used in patients waiting for major surgery to improve respiratory muscle function and to reduce the risk of postoperative pulmonary complications (PPCs). Currently, the mechanism of action of IMT in reducing PPCs is still unclear. Therefore, we investigated the associations between preoperative IMT variables and the occurrence of PPCs in patients with esophageal cancer. METHODS A multi-center cohort study was conducted in subjects scheduled for esophagectomy, who followed IMT as part of a prehabilitation program. IMT variables included maximum inspiratory pressure (PImax) before and after IMT and IMT intensity variables including training load, frequency, and duration. Associations between PImax and IMT intensity variables and PPCs were analyzed using independent samples t tests and logistic regression analyses, corrected for age and pulmonary comorbidities and stratified for the occurrence of anastomotic leakages. RESULTS Eighty-seven subjects were included (69 males; mean age 66.7 ± 7.3 y). A higher PImax (odds ratio 1.016, P = .07) or increase in PImax during IMT (odds ratio 1.020, P = .066) was not associated with a reduced risk of PPCs after esophagectomy. Intensity variables of IMT were also not associated (P ranging from .16 to .95) with PPCs after esophagectomy. Analyses stratified for the occurrence of anastomotic leakages showed no associations between IMT variables and PPCs. CONCLUSIONS This study shows that an improvement in preoperative inspiratory muscle strength during IMT and training intensity of IMT were not associated with a reduced risk on PPCs after esophagectomy. Further research is needed to investigate other possible factors explaining the mechanism of action of preoperative IMT in patients undergoing major surgery, such as the awareness of patients related to respiratory muscle function and a diaphragmatic breathing pattern.
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Affiliation(s)
- Meike C Overbeek
- Mss Overbeek and Reijneveld and Dr Dronkers are affiliated with Research Centre for Healthy and Sustainable Living, Research Group Innovation of Movement Care, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands. Drs Valkenet and Veenhof are affiliated with Research Centre for Healthy and Sustainable Living, Research Group Innovation of Movement Care, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands; and Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Center Utrecht, Brain Centre, Utrecht, Netherlands. Dr van Adrichem is affiliated with School of Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands. Dr Ruurda is affiliated with Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Elja Ae Reijneveld
- Mss Overbeek and Reijneveld and Dr Dronkers are affiliated with Research Centre for Healthy and Sustainable Living, Research Group Innovation of Movement Care, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands. Drs Valkenet and Veenhof are affiliated with Research Centre for Healthy and Sustainable Living, Research Group Innovation of Movement Care, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands; and Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Center Utrecht, Brain Centre, Utrecht, Netherlands. Dr van Adrichem is affiliated with School of Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands. Dr Ruurda is affiliated with Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Karin Valkenet
- Mss Overbeek and Reijneveld and Dr Dronkers are affiliated with Research Centre for Healthy and Sustainable Living, Research Group Innovation of Movement Care, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands. Drs Valkenet and Veenhof are affiliated with Research Centre for Healthy and Sustainable Living, Research Group Innovation of Movement Care, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands; and Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Center Utrecht, Brain Centre, Utrecht, Netherlands. Dr van Adrichem is affiliated with School of Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands. Dr Ruurda is affiliated with Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Edwin J van Adrichem
- Mss Overbeek and Reijneveld and Dr Dronkers are affiliated with Research Centre for Healthy and Sustainable Living, Research Group Innovation of Movement Care, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands. Drs Valkenet and Veenhof are affiliated with Research Centre for Healthy and Sustainable Living, Research Group Innovation of Movement Care, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands; and Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Center Utrecht, Brain Centre, Utrecht, Netherlands. Dr van Adrichem is affiliated with School of Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands. Dr Ruurda is affiliated with Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jaap J Dronkers
- Mss Overbeek and Reijneveld and Dr Dronkers are affiliated with Research Centre for Healthy and Sustainable Living, Research Group Innovation of Movement Care, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands. Drs Valkenet and Veenhof are affiliated with Research Centre for Healthy and Sustainable Living, Research Group Innovation of Movement Care, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands; and Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Center Utrecht, Brain Centre, Utrecht, Netherlands. Dr van Adrichem is affiliated with School of Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands. Dr Ruurda is affiliated with Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jelle P Ruurda
- Mss Overbeek and Reijneveld and Dr Dronkers are affiliated with Research Centre for Healthy and Sustainable Living, Research Group Innovation of Movement Care, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands. Drs Valkenet and Veenhof are affiliated with Research Centre for Healthy and Sustainable Living, Research Group Innovation of Movement Care, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands; and Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Center Utrecht, Brain Centre, Utrecht, Netherlands. Dr van Adrichem is affiliated with School of Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands. Dr Ruurda is affiliated with Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Cindy Veenhof
- Mss Overbeek and Reijneveld and Dr Dronkers are affiliated with Research Centre for Healthy and Sustainable Living, Research Group Innovation of Movement Care, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands. Drs Valkenet and Veenhof are affiliated with Research Centre for Healthy and Sustainable Living, Research Group Innovation of Movement Care, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands; and Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Center Utrecht, Brain Centre, Utrecht, Netherlands. Dr van Adrichem is affiliated with School of Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands. Dr Ruurda is affiliated with Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
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de Aquino TN, Prado JP, Crisafulli E, Clini EM, Galdino G. Efficacy of Respiratory Muscle Training in the Immediate Postoperative Period of Cardiac Surgery: A Systematic Review and Meta-Analysis. Braz J Cardiovasc Surg 2024; 39:e20220165. [PMID: 38315040 PMCID: PMC10836657 DOI: 10.21470/1678-9741-2022-0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 07/19/2023] [Indexed: 02/07/2024] Open
Abstract
INTRODUCTION This study aimed to evaluate the efficacy of respiratory muscle training during the immediate postoperative period of cardiac surgery on respiratory muscle strength, pulmonary function, functional capacity, and length of hospital stay. METHODS This is a systematic review and meta-analysis. A comprehensive search on PubMed®, Excerpta Medica Database (or Embase), Cumulative Index of Nursing and Allied Health Literature (or CINAHL), Latin American and Caribbean Health Sciences Literature (or LILACS), Scientific Electronic Library Online (or SciELO), Physiotherapy Evidence Database (or PEDro), and Cochrane Central Register of Controlled Trials databases was performed. A combination of free-text words and indexed terms referring to cardiac surgery, coronary artery bypass grafting, respiratory muscle training, and clinical trials was used. A total of 792 studies were identified; after careful selection, six studies were evaluated. RESULTS The studies found significant improvement after inspiratory muscle training (IMT) (n = 165, 95% confidence interval [CI] 9.68, 21.99) and expiratory muscle training (EMT) (n = 135, 95% CI 8.59, 27.07) of maximal inspiratory pressure and maximal expiratory pressure, respectively. Also, IMT increased significantly (95% CI 19.59, 349.82, n = 85) the tidal volume. However, no differences were found in the peak expiratory flow, functional capacity, and length of hospital stay after EMT and IMT. CONCLUSION IMT and EMT demonstrated efficacy in improving respiratory muscle strength during the immediate postoperative period of cardiac surgery. There was no evidence indicating the efficacy of IMT for pulmonary function and length of hospital stay and the efficacy of EMT for functional capacity.
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Affiliation(s)
- Tarcísio Nema de Aquino
- Instituto de Ciências da Motricidade, Universidade Federal
de Alfenas, Alfenas, Minas Gerais, Brazil
- Department of Rehabilitation and Cardiology, Hospital Santa
Lúcia, Poços de Caldas, Minas Gerais, Brazil
| | - João Paulo Prado
- Instituto de Ciências da Motricidade, Universidade Federal
de Alfenas, Alfenas, Minas Gerais, Brazil
| | - Ernesto Crisafulli
- Department of Medicine and Surgery, Respiratory Disease and Lung
Function Unit, University of Parma, Parma, Italy
| | - Enrico Maria Clini
- Department of Medical and Surgical Sciences, University of Modena
and Reggio Emilia and University Hospital of Modena Policlinico, Modena, Italy
| | - Giovane Galdino
- Instituto de Ciências da Motricidade, Universidade Federal
de Alfenas, Alfenas, Minas Gerais, Brazil
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Zhou H, Liu F, Liu Y, He X, Ma H, Xu M, Wang H, Zhang G, Cai X, Chen JY, Guo L, Chen J. Protocol for the PORT study: short-term perioperative rehabilitation to improve outcomes in cardiac valvular surgery - a randomised control trial. BMJ Open 2023; 13:e074837. [PMID: 38135333 DOI: 10.1136/bmjopen-2023-074837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2023] Open
Abstract
INTRODUCTION Perioperative rehabilitation (PORT) has shown a positive effect on patients undergoing cardiac surgery. However, there are minimal data on the impact of short-term PORT in cardiac surgery, which is associated with higher postoperative morbidity and mortality. The trial will assess the efficacy of short-term PORT in reducing in-hospital mortality, postoperative pulmonary complications and length of stay, compared with the usual care in cardiac surgical patients. METHODS AND ANALYSIS This is a single-centre prospective, randomised, open, controlled trial with a 1:1 ratio. Consecutive 800 adult patients undergoing elective valve surgery will be randomised to either usual care or in-hospital short-term PORT that consists of education, inspiratory muscle training, active cycle of breathing techniques and early mobilisation. The primary outcome of this study will be a composite of in-hospital all-cause mortality, incidence of postoperative pulmonary complications and the ratio of postoperative hospitalisation >7 days. ETHICS AND DISSEMINATION The PORT study was granted by the Medical Research Ethics Committee of Guangdong Provincial People's Hospital in August 2018. Findings will be disseminated to patients, clinicians and commissioning groups through peer-reviewed publication. TRIAL REGISTRATION NUMBER NCT03709511.
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Affiliation(s)
- Haofeng Zhou
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Fengyao Liu
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Yuanhui Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Xuyu He
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Huan Ma
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Mingyu Xu
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Haochen Wang
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Guolin Zhang
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Xiangyu Cai
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Ji-Yan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Lan Guo
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Jimei Chen
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China
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Rezaian S, Asadi Gharabaghi M, Rahimi B, Gholamzadeh M. Concordance between ARISCAT risk score and cardiopulmonary exercise test values in risk prediction of postoperative pulmonary complications of major abdominal surgeries in a tertiary cancer hospital: A cross-sectional study. Health Sci Rep 2023; 6:e1740. [PMID: 38078301 PMCID: PMC10704107 DOI: 10.1002/hsr2.1740] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/15/2023] [Accepted: 11/13/2023] [Indexed: 10/16/2024] Open
Abstract
Background and Aims Pulmonary complications are common after surgery. They include vascular thrombosis, pneumonia, respiratory failure (RF), and pain-related atelectasis. There are a number of models to predict the risk of postoperative respiratory events other than thrombosis. The aim of this study was to explore the correlation of assess respiratory risk in surgical patients in Catalonia (ARISCAT) scoring and cardiopulmonary exercise test (CPET) values in prediction of postoperative pulmonary complications (PPCs). Methods Cancer patients referred to a tertiary hospital for elective major abdominal surgeries were studied. Patients were evaluated by ARISCAT score and then CPET was performed to determine the risk of surgery based on maximal oxygen consumption (VO2) value. Patients were followed for RF occurrence up to 72 h after surgery. Finally, the concordance of ARISCAT score and CPET values was evaluated in risk prediction of PPCs. Results The results showed that parameters VO2, ARISCAT score, and anaerobic threshold could predict postoperative RF. Of these parameters, ARISCAT showed the highest sensitivity (100%) and the highest specificity (90.5%) compared with other parameters (Youden's J statistic = 0.905). However, VO2 value showed the highest validity. The percentage of agreement between different subgroups (low, medium, and high) of both criteria (VO2 and ARISCAT) was equal to 81.45% (p < 0.001) and the ϰ coefficient of the given weight was equal to 0.54 (p < 0.001), indicating a good agreement between these two criteria. Conclusion ARISCAT scoring showed high sensitivity and specificity to PPCs in cancer patients and good correlation with CPET value for prediction of PPCs. Therefore, it is a reliable and robust risk prediction tool in major abdominal surgeries on cancer patients.
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Affiliation(s)
- Somaye Rezaian
- Department of Pulmonary MedicineAlborz University of Medical sciencesTehranIran
| | - Mehrnaz Asadi Gharabaghi
- Department of Pulmonary Medicine, Shariati HospitalTehran University of Medical SciencesTehranIran
| | - Besharat Rahimi
- Department of Pulmonary Medicine, Imam Khomeini HospitalTehran University of Medical SciencesTehranIran
| | - Marsa Gholamzadeh
- Department of Health Information Management and Medical Informatics, School of Allied Medical SciencesTehran University of Medical SciencesTehranIran
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Bingül ES, Şentürk NM, Kaynar AM. Prehabilitation: a narrative review focused on exercise therapy for the prevention of postoperative pulmonary complications following lung resection. Front Med (Lausanne) 2023; 10:1196981. [PMID: 37849492 PMCID: PMC10577193 DOI: 10.3389/fmed.2023.1196981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/15/2023] [Indexed: 10/19/2023] Open
Abstract
Extensive preventive strategies in the perioperative period are popular worldwide. Novel "prehabilitation" approaches are being defined for every individual surgical discipline. With intention to reduce perioperative morbidity, "prehabilitation" was developed to increase "physical wellness" considering exercise capacity, nutritional status, and psychological support. Thus, prehabilitation could be well-suited for patients undergoing lung cancer surgery. Theoretically, improving physical condition may increase the chances of having a better post-operative course, especially among frail patients. In this review, we describe the concept of prehabilitation with possible benefits, its role in the Enhanced Recovery After Surgery protocols, and its potential for the future.
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Affiliation(s)
- Emre Sertaç Bingül
- Department of Anesthesiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Nüzhet Mert Şentürk
- Department of Anesthesiology, Acibadem University School of Medicine, Istanbul, Türkiye
| | - Ata Murat Kaynar
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA, United States
- The Center for Innovation in Pain Care (CIPC), University of Pittsburgh, Pittsburgh, PA, United States
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, United States
- The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, University of Pittsburgh, Pittsburgh, PA, United States
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Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
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Yao W, Wang W, Tang W, Lv Q, Ding W. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune inflammation index (SII) to predict postoperative pneumonia in elderly hip fracture patients. J Orthop Surg Res 2023; 18:673. [PMID: 37697317 PMCID: PMC10496383 DOI: 10.1186/s13018-023-04157-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 09/01/2023] [Indexed: 09/13/2023] Open
Abstract
PURPOSE Investigate the association between the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) about the presence of postoperative pneumonia (POP) in geriatric patients with hip fractures. Compare the predictive value of these biomarkers for POP and assess their potential for early detection of POP. METHODS We retrospectively included elderly patients with hip fractures who underwent surgical treatment at our institution. POP was diagnosed according to the guidelines provided by the American Thoracic Society. We collected neutrophil, lymphocyte, and platelet counts upon admission to calculate the NLR, PLR, and SII. Receiver operating characteristic curves were utilized to establish the optimal cutoff values for each index. Multivariate logistic regression analysis and propensity score matching analysis were utilized to assess the independent association between each index and POP after adjusting for demographic, comorbidity, and surgery-related variables. RESULTS The study included a total of 1199 patients, among whom 111 cases (9.26%) developed POP. NLR exhibited the highest predictive value for POP in elderly patients with hip fractures compared to PLR and SII (AUC = 0.648, 95% CI 0.594-0.701). A high NLR, using the optimal cutoff value of 5.84, was significantly associated with an increased incidence of POP (OR = 2.24, 95% CI 1.43-3.51). This finding remained statistically significant even after propensity score matching (OR = 2.04, 95% CI 1.31-3.20). CONCLUSIONS Among the three inflammatory/immune markers considered, the NLR demonstrates the highest reliability as a predictor for POP in elderly patients with hip fractures. Therefore, it serves as a valuable tool for early identification.
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Affiliation(s)
- Wei Yao
- Department of Orthopedics, Dandong Central Hospital, China Medical University, No. 338 Jinshan Street, Zhenxing District, Dandong, 118002, Liaoning Province, People's Republic of China
| | - Wei Wang
- Department of Orthopedics, Dandong Central Hospital, China Medical University, No. 338 Jinshan Street, Zhenxing District, Dandong, 118002, Liaoning Province, People's Republic of China
| | - Wanyun Tang
- Department of Orthopedics, Dandong Central Hospital, China Medical University, No. 338 Jinshan Street, Zhenxing District, Dandong, 118002, Liaoning Province, People's Republic of China
| | - Qiaomei Lv
- Department of Oncology, Dandong Central Hospital, China Medical University, Dandong, China
| | - Wenbo Ding
- Department of Orthopedics, Dandong Central Hospital, China Medical University, No. 338 Jinshan Street, Zhenxing District, Dandong, 118002, Liaoning Province, People's Republic of China.
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Wang ZD, Tang T, He JP, Shen C, Sun QK, Chen CJ, Qian WJ, Chen XY. Visualization Analysis of Research Trends and Hotspots in Inspiratory Muscle Training. Med Sci Monit 2023; 29:e941486. [PMID: 37661601 PMCID: PMC10487190 DOI: 10.12659/msm.941486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 07/18/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Inspiratory muscle training (IMT) aims to train inspiratory muscles based mainly on the diaphragm by applying a load resistance during the inspiratory process. Many papers related to IMT have been published in various journals; however, no articles objectively and directly present the development trends and research hotspots of IMT. Therefore, this study used CiteSpace to visually analyze recent IMT-related publications to provide valuable information for future IMT-related studies. MATERIAL AND METHODS CiteSpace was applied to analyze the IMT-related publications by countries, institutions, journals, authors, references, and keywords. RESULTS We included 504 papers. The number of IMT-related publications trended upward between 2009 and 2022. Leuven had the highest number of publications by an institution. The American Journal of Respiratory and Critical Care Medicine was the most frequently co-cited journal. Half of the top 10 references cited were from Journal Citation Reports (JCR) Q1 and half were about the application of IMT in chronic obstructive pulmonary disorder. Gosselink was the author with the highest number of publications and Aldrich was the author with the highest co-citation frequency. The preponderance of studies on the surgical population and postoperative pulmonary complications reflects potential application of IMT in enhanced recovery after surgery. CONCLUSIONS This study provides scholars with important information related to IMT research. It analyzes IMT research trends and status, which can help researchers identify primary topics in the field and find ways to explore new research directions to promote the application of IMT in clinical practice and the cooperation of IMT-related disciplines.
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Affiliation(s)
- Zhao-Di Wang
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, PR China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, PR China
| | - Tong Tang
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, PR China
| | - Jin-Peng He
- Department of Rehabilitation Medicine, The First People’s Hospital of Yancheng, Yancheng, Jiangsu, PR China
- Department of Rehabilitation Medicine, Yancheng First Hospital, Affiliated Hospital of Nanjing University Medical School, Yancheng, Jiangsu, PR China
| | - Chao Shen
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, PR China
| | - Qi-Kui Sun
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, PR China
| | - Chuan-Juan Chen
- Department of Nursing, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, PR China
| | - Wen-Jun Qian
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, PR China
| | - Xin-Yuan Chen
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, PR China
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Xiang Y, Zhao Q, Luo T, Zeng L. Inspiratory muscle training to reduce risk of pulmonary complications after coronary artery bypass grafting: a systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1223619. [PMID: 37560113 PMCID: PMC10408668 DOI: 10.3389/fcvm.2023.1223619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 06/27/2023] [Indexed: 08/11/2023] Open
Abstract
Background Pulmonary complications occur in a substantial proportion of patients who undergo coronary artery bypass grafting. Inspiratory muscle training (IMT), a simple, well-tolerated physical therapy, has been proposed to reduce the risk of complications, but its efficacy remains controversial. Method Randomized controlled trials (RCTs) examining the influence of IMT on the risk of pulmonary complications after coronary artery bypass grafting were identified from PubMed, Embase, CENTRAL, CINAL, and Web of Science through March 2023. Data were meta-analyzed for the primary outcomes of pulmonary complications, defined as pneumonia, pleural effusion, and atelectasis; and in terms of the secondary outcomes of maximum inspiratory pressure, maximum expiratory pressure, length of hospitalization, 6 min walk test, and peak expiratory flow and other outcomes. Risk of bias and quality of evidence assessments were carried out using the RoB 2.0 and Grading of Recommendations Assessment, Development and Evaluation (GRADE) applied to primary outcomes of pulmonary complications. Results Data from eight RCTs involving 755 patients were meta-analyzed. IMT was associated with a significantly lower risk of postoperative pneumonia [relative risk (RR) 0.39, 95% confidence interval (CI) 0.25-0.62, P < 0.0001] and atelectasis (RR 0.43, 95% CI 0.27-0.67, P = 0.0002), but not pleural effusion (RR 1.09, 95% CI 0.62-1.93, P = 0.76). IMT was associated with significantly better maximum inspiratory pressure (preoperative: mean difference (MD) 16.55 cmH2O, 95% CI 13.86-19.24, P < 0.00001; postoperative: mean difference (MD) 8.99 cmH2O, 95% CI 2.39-15.60, P = 0.008) and maximum expiratory pressure (MD 7.15 cmH2O, 95% CI: 1.52-12.79, P = 0.01), and with significantly shorter hospitalization (MD -1.71 days, 95% CI -2.56 to -0.87, P < 0.001). IMT did not significantly affect peak expiratory flow or distance traveled during the 6 min walk test. Conclusions The available evidence from medium and high quality trials suggests that IMT can significantly decrease the risk of pneumonia and atelectasis after coronary artery bypass grafting while shortening hospitalization and improving the strength of respiratory muscles. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42023415817.
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Affiliation(s)
| | | | | | - Ling Zeng
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
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Cordeiro ALL, Soares LO, Gomes-Neto M, Petto J. Inspiratory Muscle Training in Patients in the Postoperative Phase of Cardiac Surgery: A Systematic Review and Meta-Analysis. Ann Rehabil Med 2023; 47:162-172. [PMID: 37403313 PMCID: PMC10326391 DOI: 10.5535/arm.23022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/11/2023] [Accepted: 05/23/2023] [Indexed: 07/06/2023] Open
Abstract
To review the evidence about inspiratory muscle training (IMT) in patients in postoperative of cardiac surgery. We conducted this systematic review used the databases Ovid, LILACS, CINAHL, PubMed, PEDro, and CENTRAL. Randomized clinical trials that addressed IMT after cardiac surgery were selected. The outcomes assessed were maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), tidal volume (TV), peak expiratory flow (PEF), functional capacity (6-minute walk test) and length of hospital stay. The mean difference between groups and the respective 95% confidence interval (CI) were calculated and used to quantify the effect of continuous outcomes. Seven studies were selected. The IMT was superior to the control over MIP 15.77 cmH2O (95% CI, 5.95-25.49), MEP 15.87 cmH2O (95% CI, 1.16-30.58), PEF 40.98 L/min (95% CI, 4.64-77.32), TV 184.75 mL (95% CI, 19.72-349.77), hospital stay -1.25 days (95% CI, -1.77 to -0.72), but without impact on functional capacity 29.93 m (95% CI, -27.59 to 87.45). Based on the results presented, IMT was beneficial as a form of treatment for patients after cardiac surgery.
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Affiliation(s)
- André Luiz Lisboa Cordeiro
- Department of Medicine and Human Health, Bahiana School of Medicine and Public Health, Salvador, Brazil
- Department of Physical Therapy, Centro Universitário Nobre, Feira de Santana, Brazil
| | - Lucas Oliveira Soares
- Department of Physical Therapy, Centro Universitário Nobre, Feira de Santana, Brazil
- Physiotherapy Department, Hospital Geral Clériston Andrade, Feira de Santana, Brazil
| | - Mansueto Gomes-Neto
- Department of Physical Therapy, Universidade Federal da Bahia, Salvador, Brazil
| | - Jefferson Petto
- Department of Medicine and Human Health, Bahiana School of Medicine and Public Health, Salvador, Brazil
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Yin X, Wang J, Xu Z, Qian F, Liu S, Cai Y, Jiang Z, Zhang X, Gu W. Comparison of 6-min walk test distance vs. estimated maximum oxygen consumption for predicting postoperative pulmonary complications in patients undergoing upper abdominal surgery: a prospective cohort study. Perioper Med (Lond) 2023; 12:18. [PMID: 37221581 DOI: 10.1186/s13741-023-00309-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 05/08/2023] [Indexed: 05/25/2023] Open
Abstract
OBJECTIVE The present study aims to evaluate the predictive ability of estimated maximum oxygen consumption (e[Formula: see text]O2max) and 6-min walk distance (6MWD) for postoperative pulmonary complications (PPCs) in adult surgical patients undergoing major upper abdominal surgery. METHOD This study was conducted by collecting data prospectively from a single center. The two predictive variables in the study were defined as 6MWD and e[Formula: see text]O2max. Patients scheduled for elective major upper abdominal surgery from March 2019 to May 2021 were included. The 6MWD was measured for all patients before surgery. e[Formula: see text]O2max was calculated using the regression model of Burr, which uses 6MWD, age, gender, weight, and resting heart rate (HR) to predict aerobic fitness. The patients were categorized into PPC and non-PPC group. The sensitivity, specificity, and optimum cutoff values for 6MWD and e[Formula: see text]O2max were calculated to predict PPCs. The area under the receiver operating characteristic curve (AUC) of 6MWD or e[Formula: see text]O2max was constructed and compared using the Z test. The primary outcome measure was the AUC of 6MWD and e[Formula: see text]O2max in predicting PPCs. In addition, the net reclassification index (NRI) was calculated to assess ability of e[Formula: see text]O2max compared with 6MWT in predicting PPCs. RESULTS A total of 308 patients were included 71/308 developed PPCs. Patients unable to complete the 6-min walk test (6MWT) due to contraindications or restrictions, or those taking beta-blockers, were excluded. The optimum cutoff point for 6MWD in predicting PPCs was 372.5 m with a sensitivity of 63.4% and specificity of 79.3%. The optimum cutoff point for e[Formula: see text]O2max was 30.8 ml/kg/min with a sensitivity of 91.6% and specificity of 79.3%. The AUC for 6MWD in predicting PPCs was 0.758 (95% confidence interval (CI): 0.694-0.822), and the AUC for e[Formula: see text]O2max was 0.912 (95%CI: 0.875-0.949). A significantly increased AUC was observed in e[Formula: see text]O2max compared to 6MWD in predicting PPCs (P < 0.001, Z = 4.713). And compared with 6MWT, the NRI of e[Formula: see text]O2max was 0.272 (95%CI: 0.130, 0.406). CONCLUSION The results suggested that e[Formula: see text]O2max calculated from the 6MWT is a better predictor of PPCs than 6MWD in patients undergoing upper abdominal surgery and can be used as a tool to screen patients at risk of PPCs.
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Affiliation(s)
- Xin Yin
- Department of Anesthesiology, Huadong Hospital Affiliated to Fudan University, No 221, West Yan'an Road, Shanghai, 200040, China
| | - Jingwen Wang
- Department of Oncology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Zhibo Xu
- Department of Anesthesiology, Huadong Hospital Affiliated to Fudan University, No 221, West Yan'an Road, Shanghai, 200040, China
| | - Fuyong Qian
- Department of Anesthesiology, Huadong Hospital Affiliated to Fudan University, No 221, West Yan'an Road, Shanghai, 200040, China
| | - Songbin Liu
- Department of Anesthesiology, Huadong Hospital Affiliated to Fudan University, No 221, West Yan'an Road, Shanghai, 200040, China
| | - Yuxi Cai
- Department of Anesthesiology, Huadong Hospital Affiliated to Fudan University, No 221, West Yan'an Road, Shanghai, 200040, China
| | - Zhaoshun Jiang
- Department of Anesthesiology, Huadong Hospital Affiliated to Fudan University, No 221, West Yan'an Road, Shanghai, 200040, China
| | - Xixue Zhang
- Department of Anesthesiology, Huadong Hospital Affiliated to Fudan University, No 221, West Yan'an Road, Shanghai, 200040, China.
| | - Weidong Gu
- Department of Anesthesiology, Huadong Hospital Affiliated to Fudan University, No 221, West Yan'an Road, Shanghai, 200040, China.
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Wang J, Wang YQ, Shi J, Yu PM, Guo YQ. Effect of preoperative inspiratory muscle training on postoperative outcomes in patients undergoing cardiac surgery: A systematic review and meta-analysis. World J Clin Cases 2023; 11:2981-2991. [PMID: 37215418 PMCID: PMC10198094 DOI: 10.12998/wjcc.v11.i13.2981] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/10/2023] [Accepted: 03/31/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Cardiovascular disease is the most prevalent disease worldwide and places a great burden on the health and economic welfare of patients. Cardiac surgery is an important way to treat cardiovascular disease, but it can prolong mechanical ventilation time, intensive care unit (ICU) stay, and postoperative hospitalization for patients. Previous studies have demonstrated that preoperative inspiratory muscle training could decrease the incidence of postoperative pulmonary complications.
AIM To explore the effect of preoperative inspiratory muscle training on mechanical ventilation time, length of ICU stay, and duration of postoperative hospitalization after cardiac surgery.
METHODS A literature search of PubMed, Web of Science, Cochrane Library, EMBASE, China National Knowledge Infrastructure, WanFang, and the China Science and Technology journal VIP database was performed on April 13, 2022. The data was independently extracted by two authors. The inclusion criteria were: (1) Randomized controlled trial; (2) Accessible as a full paper; (3) Patients who received cardiac surgery; (4) Preoperative inspiratory muscle training was implemented in these patients; (5) The study reported at least one of the following: Mechanical ventilation time, length of ICU stay, and/or duration of postoperative hospitalization; and (6) In English language.
RESULTS We analyzed six randomized controlled trials with a total of 925 participants. The pooled mean difference of mechanical ventilation time was -0.45 h [95% confidence interval (CI): -1.59-0.69], which was not statistically significant between the intervention group and the control group. The pooled mean difference of length of ICU stay was 0.44 h (95%CI: -0.58-1.45). The pooled mean difference of postoperative hospitalization was -1.77 d in the intervention group vs the control group [95%CI: -2.41-(-1.12)].
CONCLUSION Preoperative inspiratory muscle training may decrease the duration of postoperative hospitalization for patients undergoing cardiac surgery. More high-quality studies are needed to confirm our conclusion.
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Affiliation(s)
- Jing Wang
- Department of Cardiovascular Surgery, Sichuan University West China Hospital, Chengdu 610041, Sichuan Province, China
| | - Yu-Qiang Wang
- Department of Cardiovascular Surgery, Sichuan University West China Hospital, Chengdu 610041, Sichuan Province, China
| | - Jun Shi
- Department of Cardiovascular Surgery, Sichuan University West China Hospital, Chengdu 610041, Sichuan Province, China
| | - Peng-Ming Yu
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ying-Qiang Guo
- Department of Cardiovascular Surgery, Sichuan University West China Hospital, Chengdu 610041, Sichuan Province, China
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Herzberg J, Guraya SY, Merkle D, Strate T, Honarpisheh H. The role of prophylactic administration of CPAP in general surgical wards after open visceral surgery in reducing postoperative pneumonia-a retrospective cohort study. Langenbecks Arch Surg 2023; 408:167. [PMID: 37120478 PMCID: PMC10148695 DOI: 10.1007/s00423-023-02899-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 04/14/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND Postoperative pneumonia is a main adverse event that causes increased postoperative morbidity and prolonged length of hospital stay leading to high postoperative mortality. Continuous positive airway pressure (CPAP) is a type of non-invasive ventilation for the delivery of a positive airway pressure during respiration. In this study, we evaluated the impact of postoperative prophylactic CPAP on prevention of pneumonia in patients after open visceral surgery. METHODS In this observational cohort study, we compared the rates of postoperative pneumonia in patients who underwent open major visceral surgery from January 2018 till August 2020 in the study and control group. The study group had postoperative prophylactic sessions of CPAP for 15 min, 3-5 times a day and a repeated spirometer training was also performed in the general surgical ward. The control group received only the postoperative spirometer training as a prophylactic measure against postoperative pneumonia. The chi-square test was used to measure the relationships between categorical variables, and a binary regression analysis determined the correlation between independent and dependent variables. RESULTS A total of 258 patients met the inclusion criteria who had open visceral surgery for various clinical illnesses. There were 146 men (56.6%) and 112 women with a mean age of 68.62 years. As many as 142 patients received prophylactic CPAP and they were grouped into the study group, whereas 116 patients without prophylactic CPAP were placed in the control group. Overall, the rate of postoperative pneumonia was significantly less in the study group (5.6% vs. 25.9% in the control group; p-value < 0.0001), which could be confirmed by the regression analysis (OR 0.118, CI 95% 0.047-0.295, p < 0.001). CONCLUSION Postoperative intermittent CPAP after open visceral surgery can be performed in a general surgical ward. Our study showed a significant association with a low rate of postoperative pneumonia, especially in high-risk patients. This leads to a significantly shorter postoperative hospital stay especially in high-risk patients after upper gastrointestinal surgery. TRIAL REGISTRATION NUMBER DRKS00028988, 04.05.2022, retrospectively registered.
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Affiliation(s)
- Jonas Herzberg
- Department of Surgery, Division of General, Abdominal and Thoracic Surgery, Krankenhaus Reinbek St. Adolf-Stift, Hamburger Strasse 41, 21465, Reinbek, Germany.
| | - Salman Yousuf Guraya
- Clinical Sciences Department, College of Medicine, University of Sharjah, P. O. Box 27272, Sharjah, United Arab Emirates
| | - Daniel Merkle
- Department of Surgery, Division of General, Abdominal and Thoracic Surgery, Krankenhaus Reinbek St. Adolf-Stift, Hamburger Strasse 41, 21465, Reinbek, Germany
| | - Tim Strate
- Department of Surgery, Division of General, Abdominal and Thoracic Surgery, Krankenhaus Reinbek St. Adolf-Stift, Hamburger Strasse 41, 21465, Reinbek, Germany
| | - Human Honarpisheh
- Department of Surgery, Division of General, Abdominal and Thoracic Surgery, Krankenhaus Reinbek St. Adolf-Stift, Hamburger Strasse 41, 21465, Reinbek, Germany
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Chen S, Li X, Wu Y, Li Y, Cao P, Yin Y, Chen Z. Preoperative respiratory muscle training combined with aerobic exercise improves respiratory vital capacity and daily life activity following surgical treatment for myasthenia gravis. J Cardiothorac Surg 2023; 18:160. [PMID: 37095505 PMCID: PMC10127428 DOI: 10.1186/s13019-023-02283-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/08/2023] [Indexed: 04/26/2023] Open
Abstract
OBJECTIVE The effects of preoperative respiratory muscle training (RMT) on postoperative complications in patients surgically treated for myasthenia gravis (MG) remain unclear. The present study therefore evaluated the effects of preoperative moderate-to-intense RMT and aerobic exercise, when added to respiratory physiotherapy, on respiratory vital capacity, exercise capacity, and duration of hospital stay in patients with MG. METHODS Eighty patients with MG scheduled for extended thymectomy were randomly divided into two groups. The 40 subjects in the study group (SG) received preoperative moderate-to-intense RMT and aerobic exercise in addition to respiratory physiotherapy, whereas the 40 subjects in the control group (CG) received only chest physiotherapy. Respiratory vital capacity (as determined by VC, FVC, FEV1, FEV1/FVC, and PEF) and exercise capacity (as determined by the 6-min walk test [6 MWT]) were measured pre- and postoperatively and before discharge. The duration of hospital stay and activity of daily living (ADL) were also determined. RESULTS Demographic and surgical characteristics, along with preoperative vital capacity and exercise capacity, were similar in the two groups. In the CG, VC (p = 0.001), FVC (p = 0.001), FEV1 (p = 0.002), PEF (p = 0.004), and 6MWT (p = 0.041) were significantly lower postoperatively than preoperatively, whereas the FEV1/FVC ratio did not differ significantly. Postoperative VC (p = 0.012), FVC (p = 0.030), FEV1 (p = 0.014), and PEF (p = 0.035) were significantly higher in the SG than in the CG, although 6MWT results did not differ. ADL on postoperative day 5 was significantly higher in the SG than in the CG (p = 0.001). CONCLUSION RMT and aerobic exercise can have positive effects on postoperative respiratory vital capacity and daily life activity, and would enhance recovery after surgery in MG patients.
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Affiliation(s)
- Sai Chen
- Center for Private Medical Service and Healthcare, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Xin Li
- Department of Rehabilitation, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Yunshan Wu
- Department of Cardiothoracic Surgery of East Division, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510700, Guangdong, People's Republic of China
| | - Yana Li
- Department of Cardiothoracic Surgery of East Division, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510700, Guangdong, People's Republic of China
| | - Peili Cao
- Department of Cardiothoracic Surgery of East Division, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510700, Guangdong, People's Republic of China
| | - Yuchun Yin
- Center for Private Medical Service and Healthcare, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Zhenguang Chen
- Department of Cardiothoracic Surgery of East Division, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510700, Guangdong, People's Republic of China.
- Department of Thoracic Surgery, The First Affiliated Hospital, Sun Yat-Sen University, No. 58, Zhongshan Road II, Guangzhou, 510080, Guangdong, People's Republic of China.
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Fraile Olivero CA, Jarabo Sarceda JR, Fernández Martín E, Santos Capa P, Arribas Manzanal PD, Gómez Martínez AM, Calatayud Gastardi J, Hernando Trancho F. Implementation of a perioperative care App in elective thoracic surgery. Cir Esp 2023; 101:265-273. [PMID: 36108953 DOI: 10.1016/j.cireng.2022.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/26/2022] [Indexed: 04/21/2023]
Abstract
INTRODUCTION The design and implementation inconsistency of perioperative care programs limits their universalization, and it is where e-Health can standardize these processes. The objective of the study is to create a Smartphone App with a perioperative care program, implement it in a group of patients scheduled for a thoracic surgical procedure, and evaluates its use. METHODS A prospective and descriptive study. We created a Smartphone app (Fissios App) which contains 40 perioperative recommendations and 10 chest physical exercises. Patients were recommended to use it before and after surgery; to measure its use, we created and applied a questionnaire. A descriptive analysis of patient variables and questionnaire responses was performed and their association evaluated. RESULTS One hundred four patients were included, 60.3% were men with a median age of 62 years (51-71), and 26.72% had completed high school. The 89.3% of patients highlighted the ease of downloading and setting up the app. More than 90% of patients positively assessed clarity in explaining chest physical exercises and perioperative recommendations. One hundred four (79.4%) patients highlighted the contribution of the use of the app during the preoperative period to face the postoperative period. CONCLUSIONS We created a Smartphone app (Fissios App) with a perioperative care program and it was successfully implemented regardless of the age or educational level of patients. The tool clearly explains the information contained and the patients reported that its use before surgery helped them to face the postoperative period, with an appropriate level of physical demand and time of use.
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Affiliation(s)
| | | | | | - Passio Santos Capa
- Servicio de Medicina Física y Rehabilitación, Hospital Clínico San Carlos, Madrid, Spain
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Gu YX, Wang XY, Xu MX, Qian JJ, Wang Y. Analysis of the impact of ERAS-based respiratory function training on older patients’ ability to prevent pulmonary complications after abdominal surgery. World J Gastrointest Surg 2023; 15:201-210. [PMID: 36896307 PMCID: PMC9988635 DOI: 10.4240/wjgs.v15.i2.201] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/11/2023] [Accepted: 02/01/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND In China, as the population grows older, the number of elderly people who have died from respiratory problems has increased.
AIM To investigate whether enhanced recovery after surgery (ERAS)-based respiratory function training may help older patients who had abdominal surgery suffer fewer pulmonary problems, shorter hospital stays, and improved lung function.
METHODS The data of 231 elderly individuals having abdominal surgery was retrospectively analyzed. Based on whether ERAS-based respiratory function training was provided, patients were divided into ERAS group (n = 112) and control group (n = 119). Deep vein thrombosis (DVT), pulmonary embolism (PE), and respiratory tract infection (RTI) were the primary outcome variables. Secondary outcome variables included the Borg score Scale, FEV1/FVC and postoperative hospital stay.
RESULTS The percentage of 18.75% of ERAS group participants and 34.45% of control group participants, respectively, had respiratory infections (P = 0.007). None of the individuals experienced PE or DVT. The ERAS group’s median postoperative hospital stay was 9.5 d (3-21 d) whereas the control groups was 11 d (4-18 d) (P = 0.028). The Borg score decreased on the 4th d following surgery in the ERAS group compared to the 2nd d prior (P = 0.003). The incidence of RTIs was greater in the control group than in the ERAS group among patients who spent more than 2 d in the hospital before surgery (P = 0.029).
CONCLUSION ERAS-based respiratory function training may reduce the risk of pulmonary complications in older individuals undergoing abdominal surgery.
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Affiliation(s)
- Yue-Xia Gu
- Department of Nursing, Shanghai Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai 200434, China
| | - Xin-Yu Wang
- Department of General Surgery, Shanghai Fourth People’s Hospital School of Medicine Tongji University, Shanghai 200434, China
| | - Mei-Xia Xu
- Department of Nursing, Shanghai Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai 200434, China
| | - Jia-Jie Qian
- Department of Nursing, Shanghai Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai 200434, China
| | - Yan Wang
- Department of Nursing, Shanghai Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai 200434, China
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Schindele D, Suralis A, Schlottke C, McDonough J, Müller-Wolff T. [Are we missing the first step? : An online expert survey in a mixed methods design on current state analysis of perioperative risk estimation and preoperative preparation of patients over 65 years old in Germany]. DIE ANAESTHESIOLOGIE 2023; 72:253-260. [PMID: 36799970 DOI: 10.1007/s00101-023-01261-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 12/02/2022] [Accepted: 01/11/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND The proportion of patients over 65 years of age in surgical care is increasing in Germany. Frailty represents a relevant problem in the perioperative care of older patients and has a negative impact on the postoperative outcome. The individual degree of frailty can be influenced. Multimodal prehabilitation concepts can contribute to improving the degree of frailty in the perioperative care of affected patients. As a multidimensional syndrome, frailty is related to the aging process, affects multiple organ systems and typically leads to increased vulnerability to internal and external stressors. This is accompanied by a decrease in homeostatic reserves and resilience, which implies an increased risk of several adverse health outcomes, such as loss of physical function and quality of life. Prehabilitation is described as a multimodal concept to prepare patients preoperatively in the best possible way for elective surgical procedures, thereby minimizing postoperative complications and improving the patients' outcome. METHOD Current state analysis of perioperative care of patients over the age of 65 years in relation to frailty assessment and the use of prehabilitation concepts. Conducting a multicenter online survey of anesthesiology experts (n = 189) in German anesthesiology departments. Survey of the preoperative preparation and assessment routine in patients aged 65 years and over using a mixed methods design questionnaire. OBJECTIVE The aim of this study was to demonstrate the applied assessments and measures taken for specific perioperative risk assessment and preoperative preparation of patients aged 65 years and over. RESULTS Specific risk assessments or additional preoperative preparation of patients older than 65 years are currently not carried out routinely. The preoperative risk assessment and preparation usually focus on ascertaining the patient's previous illnesses or diseases. Assessment instruments for assessing frailty and multimodal prehabilitation concepts are not used in clinical practice in a noteworthy quantity. CONCLUSION In German clinical practice frailty assessment and structured prehabilitation approaches in perioperative care of older patients are not broadly known or established. Multimodal prehabilitation concepts can positively influence the outcome of older patients. To this end, it should be considered good clinical practice to assess and address frailty in older patients and to establish multimodal prehabilitation approaches tailored to this patient group.
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Affiliation(s)
- Denise Schindele
- RKH Akademie, RKH Kliniken Ludwigsburg-Bietigheim gGmbH, Kurt-Lindemann-Weg 10, 71706, Markgröningen, Deutschland.
| | - Amy Suralis
- University of North Florida Brooks College of Health, Jacksonville, FL, USA
| | | | - John McDonough
- University of North Florida Brooks College of Health, Jacksonville, FL, USA
| | - Tilmann Müller-Wolff
- RKH Akademie, RKH Kliniken Ludwigsburg-Bietigheim gGmbH, Kurt-Lindemann-Weg 10, 71706, Markgröningen, Deutschland.,Hochschule für angewandte Wissenschaften München, München, Deutschland
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Sumin AN, Oleinik PA, Bezdenezhnykh AV, Bezdenezhnykh NA. Prehabilitation in Cardiovascular Surgery: The Effect of Neuromuscular Electrical Stimulation (Randomized Clinical Trial). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2678. [PMID: 36768044 PMCID: PMC9916173 DOI: 10.3390/ijerph20032678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE We aimed to determine the effects of prehabilitation with neuromuscular electrical stimulation (NMES) on muscle status and exercise capacity in patients before cardiac surgery. METHODS Preoperative elective cardiac surgery patients were randomly assigned to the NMES group or control group. Intervention in the NMES group was 7-10 sessions, whereas the control group carried out breathing exercises and an educational program. The outcome measures included a six-minute walk test (6MWT) and a muscle status assessment (knee extensor strength (KES), knee flexor strength (KFS), and handgrip strength (HS)) after the course of prehabilitation. RESULTS A total of 122 patients (NMES, n = 62; control, n = 60) completed the study. During the NMES course, no complications occurred. After the course prehabilitation KES, KFS, and 6MWT distance were significantly increased (all p < 0.001) in the NMES group compared to the control. There was no significant difference in HS before surgery. CONCLUSIONS A short-term NMES course before cardiac surgery is feasible, safe, and effective to improve preoperative functional capacity (six-minute walk distance) and the strength of stimulated muscles.
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Affiliation(s)
- Alexey N. Sumin
- Correspondence: ; Tel.: +7-(3842)-64-33-08 or +7-9039-40-86-68; Fax: (3842)-64-34-10
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Lou Y, Zhang Y, Wang Z, Zhao C, Li Z, Huang Q, Tang H, Xiao J. Large pneumothorax following thoracic and lumbar tumor surgery: Risk factors and management strategies. Front Surg 2023; 10:1066841. [PMID: 36778648 PMCID: PMC9909098 DOI: 10.3389/fsurg.2023.1066841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/09/2023] [Indexed: 01/27/2023] Open
Abstract
Objective Large pneumothorax is a rare but dangerous complication following thoracic and lumbar tumor surgery. There is little discussion about the features of large pneumothorax following spinal tumor surgery. The purpose of this study was to analyze the characteristics of postoperative pneumothorax, identify factors related to large pneumothorax, and propose a management algorithm for prevention, diagnosis, and treatment. Methods Included in this retrospective study were 118 patients who developed pneumothorax after receiving thoracic and lumbar tumor surgery between January 2015 and October 2021. A measurement of lung compression ≥20% on chest CT or x-ray was defined as large pneumothorax, and potential risk factors for large pneumothorax were identified by univariate analysis. Results Spinal tumor history and intraoperative blood loss were risk factors for large pneumothorax. The common symptoms of postoperative pneumothorax were chest pain, chest tightness and dyspnea. The mean longest transverse diameter of tumors was 6.63 ± 2.4 cm. En bloc resection was performed in 70 patients, with a mean operation time of 6.9 ± 2.5 h and mean intraoperative blood loss of 1771 ± 1387 ml. The most common pathologies were chondrosarcoma, giant cell tumors of bone, and neurogenic tumors. Conclusion During surgery, an artificial dura mater patch and a prolene suture can be used to repair the pleural and lung defects. We recommend chest CT as the preferred method for identifying postoperative pneumothorax. If a patient presents severe dyspnea, a large pneumothorax or concurrent pleural effusion, application of chest drainage is strongly recommended.
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Affiliation(s)
- Yan Lou
- Department of Orthopedic Oncology, Spine Tumor Center, Changzheng Hospital, Naval Military Medical University, ShanghaiChina
| | - Yunyan Zhang
- Department of Respiratory and Critical Care Medicine, Changzheng Hospital, Naval Military Medical University, Shanghai China
| | - Zhongzhao Wang
- Department of Respiratory and Critical Care Medicine, Changzheng Hospital, Naval Military Medical University, Shanghai China
| | - Chenglong Zhao
- Department of Orthopedic Oncology, Spine Tumor Center, Changzheng Hospital, Naval Military Medical University, ShanghaiChina
| | - Zhenxi Li
- Department of Orthopedic Oncology, Spine Tumor Center, Changzheng Hospital, Naval Military Medical University, ShanghaiChina
| | - Quan Huang
- Department of Orthopedic Oncology, Spine Tumor Center, Changzheng Hospital, Naval Military Medical University, ShanghaiChina,Correspondence: Quan Huang Hao Tang Jianru Xiao
| | - Hao Tang
- Department of Respiratory and Critical Care Medicine, Changzheng Hospital, Naval Military Medical University, Shanghai China,Correspondence: Quan Huang Hao Tang Jianru Xiao
| | - Jianru Xiao
- Department of Orthopedic Oncology, Spine Tumor Center, Changzheng Hospital, Naval Military Medical University, ShanghaiChina,Correspondence: Quan Huang Hao Tang Jianru Xiao
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Salling SL, Jensen JH, Mosegaard SB, Sørensen L, Mechlenburg I. Risk stratification for post-operative pulmonary complications following major cardiothoracic or abdominal surgery: Validation of the PPC Risk Prediction Score for physiotherapist's clinical decision-making. THE CLINICAL RESPIRATORY JOURNAL 2023; 17:229-240. [PMID: 36596755 PMCID: PMC9978899 DOI: 10.1111/crj.13579] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 12/12/2022] [Accepted: 12/21/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Patients undergoing major cardiothoracic or abdominal surgery are at increased risk of developing post-operative pulmonary complications (PPC), but respiratory physiotherapy can prevent PPC. We have previously developed the PPC Risk Prediction Score to allocate physiotherapists' resources and stratify patients into three risk groups. In this study, we performed a temporal external validation of the PPC Risk Prediction Score. Such validation is rare and adds to the originality of this study. METHODS A cohort of 360 patients, admitted to undergo elective cardiothoracic or abdominal surgery, were included. Performance and clinical usefulness of the PPC Risk Prediction Score were estimated through discrimination, calibration and clinical usefulness, and the score was updated. RESULTS The score showed c-statistics of 0.62. Related to clinical usefulness, a cut point at 8 gave a sensitivity of 0.49 and a specificity of 0.70, whereas a cut point at 12 gave a sensitivity of 0.13 and a specificity of 0.95. Two predictors included in the development sample score, thoraco-abdominal incision odds ratio (OR) 2.74 (1.12;6.71) and sternotomy OR 2.09 (1.18;3.72), were statistically significantly associated to PPC in the validation sample. CONCLUSIONS The score was not able to discriminate between patients with and without PPC; neither was the updated score, but the study identified clinically relevant risk factors for developing PPC.
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Affiliation(s)
- Sofie Langbo Salling
- Department of Clinical MedicineAarhus UniversityAarhusDenmark,Department of OrthopaedicsAarhus University HospitalAarhusDenmark
| | - Janne Hastrup Jensen
- Department of Physiotherapy and Occupational TherapyAarhus University HospitalAarhusDenmark
| | | | - Lotte Sørensen
- Department of OrthopaedicsAarhus University HospitalAarhusDenmark,Department of Physiotherapy and Occupational TherapyAarhus University HospitalAarhusDenmark
| | - Inger Mechlenburg
- Department of Clinical MedicineAarhus UniversityAarhusDenmark,Department of OrthopaedicsAarhus University HospitalAarhusDenmark,Department of Public HealthAarhus UniversityAarhusDenmark
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Zhang S, Li B, Meng X, Zuo H, Hu D. The Effects of Inspiratory Muscle Training (IMT) on Patients Undergoing Coronary Artery Bypass Graft (CABG) Surgery: A Systematic Review and Meta-Analysis. Rev Cardiovasc Med 2023; 24:16. [PMID: 39076880 PMCID: PMC11270382 DOI: 10.31083/j.rcm2401016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/22/2022] [Accepted: 09/22/2022] [Indexed: 07/31/2024] Open
Abstract
Background To determine the effects of inspiratory muscle training (IMT) alone on inspiratory muscle strength and endurance, pulmonary function, pulmonary complications, and length of hospital stay in patients undergoing coronary artery bypass graft surgery (CABG). Methods We conducted a literature search across databases (Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily; Ovid Embase; Ovid Cochrane Central Register of Controlled Trials; Ovid Cochrane Database of Systematic Reviews; and Scopus) from inception to December 2021. The eligibility criteria were randomized controlled trials that investigated the effects of IMT versus usual care or sham IMT in patients undergoing CABG. Results A total of 12 randomized clinical trials with 918 patients were included in the meta-analysis. Postoperative IMT was associated with improved maximal inspiratory pressure (MIP), maximum inspiratory pressure (PImax), and six-minute walking test (6MWT) and with a decrease in length of hospital stay (LOS). For preoperative IMT, there was statistical significance between intervention and MIP, PImax, forced expiratory volume in one second (FEV1), forced vital capacity (FVC), postoperative pulmonary complications (PPCs), and LOS. Pre- and postoperative IMT resulted in improvements in MIP. Conclusions Isolated IMT in patients who underwent CABG improved their inspiratory muscle strength and endurance, pulmonary function, and 6MWT and helped decrease postoperative pulmonary complications and the length of hospital stay.
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Affiliation(s)
- Sisi Zhang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430000 Wuhan, Hubei, China
| | - Bo Li
- Department of Thoracic Surgery, The Second Hospital of Jilin University, 130041 Changchun, Jilin, China
| | - Xiaoping Meng
- Department of Cardiovascular and Cardiac Rehabilitation, The Affiliated Hospital of Changchun Traditional Chinese Medicine, 130000 Changchun, Jilin, China
| | - Houjuan Zuo
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430000 Wuhan, Hubei, China
| | - Dayi Hu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430000 Wuhan, Hubei, China
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Fernández-Blanco R, Rincón-García D, Valero-Alcaide R, Atín-Arratibel MA, De Miguel-Diez J, Corrochano-Cardona R, Torres-Castro R, Moro-Tejedor MN. Preoperative respiratory therapy in patients undergoing surgery for lung cancer: A randomized controlled trial. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2023; 28:e1973. [PMID: 36099408 DOI: 10.1002/pri.1973] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 06/22/2022] [Accepted: 08/28/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND A preoperative respiratory therapy treatment was performed to analyze the effectiveness, with respect to postoperative air leak and pain, in patients undergoing surgery for lung cancer. OBJECTIVES To analyze air leakage and postoperative pain. MATERIAL AND METHODS Seventy one patients were studied, with a mean age of 62.58 years. Descriptive variables of gender, carcinogenic pathology, type of surgical incision and lung resection, use of glue and endostapler, and presence of adhesions were analyzed. Likewise, analysis of the quantitative variables of age, body mass index and forced expiratory volume in 1 s Two homogeneous groups resulted. Differentiated, experimental group (EG) that performed preoperative respiratory therapy and control group (CG). RESULTS There were statistically significant differences in favor of the EG with respect to postoperative air leak on days 1-2 during the performance of physiotherapy techniques, the food and during the performance of the exercises autonomously. Furthermore, differences in air leakage were observed on days 2-4 during gait. The number of patients decreased to a greater extent in the EG. Regarding pain, there were statistically significant differences in the sample on days 1-4, with greater intensity of pain in the CG and after doing physiotherapy every day except the second. CONCLUSIONS Preoperative respiratory therapy in patients undergoing surgery for lung cancer was effective in reducing the number of patients who presented postoperative air leak and reducing pain in the EG.
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Affiliation(s)
- Raquel Fernández-Blanco
- Department of Physical Therapy, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, Madrid, Spain
| | - David Rincón-García
- Department of Thoracic Surgery, Hospital Universitario Jimenez Díaz, Madrid, Spain
| | - Raquel Valero-Alcaide
- Departamento de Medicina Física y Rehabilitación-Hidrología Médica, Universidad Complutense de Madrid, Madrid, Spain
| | - María Angeles Atín-Arratibel
- Department of Radiology, Rehabilitation, and Physical Therapy, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Javier De Miguel-Diez
- Respiratory Care Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, Madrid, Spain
| | | | - Rodrigo Torres-Castro
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile.,International Physiotherapy Research Network (PhysioEvidence), Barcelona, Spain
| | - Maria Nieves Moro-Tejedor
- Nursing Research Support Unit, Hospital General Universitario Gregorio Marañon, Madrid, Spain.,Red Cross University College of Nursing, Spanish Red Cross, Autonomous University of Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
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Hall DE, Youk A, Allsup K, Kennedy K, Byard TD, Dhupar R, Chu D, Rahman AM, Wilson M, Cahalin LP, Afilalo J, Forman DE. Preoperative Rehabilitation Is Feasible in the Weeks Prior to Surgery and Significantly Improves Functional Performance. J Frailty Aging 2023; 12:267-276. [PMID: 38008976 PMCID: PMC10683858 DOI: 10.14283/jfa.2022.42] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Abstract
BACKGROUND Frailty is a multidimensional state of increased vulnerability. Frail patients are at increased risk for poor surgical outcomes. Prior research demonstrates that rehabilitation strategies deployed after surgery improve outcomes by building strength. OBJECTIVES Examine the feasibility and impact of a novel, multi-faceted prehabilitation intervention for frail patients before surgery. DESIGN Single arm clinical trial. SETTING Veterans Affairs hospital. PARTICIPANTS Patients preparing for major abdominal, urological, thoracic, or cardiac surgery with frailty identified as a Risk Analysis Index≥30. INTERVENTION Prehabilitation started in a supervised setting to establish safety and then transitioned to home-based exercise with weekly telephone coaching by exercise physiologists. Prehabilitation included (a)strength and coordination training; (b)respiratory muscle training (IMT); (c)aerobic conditioning; and (d)nutritional coaching and supplementation. Prehabilitation length was tailored to the 4-6 week time lag typically preceding each participant's normally scheduled surgery. MEASUREMENTS Functional performance and patient surveys were assessed at baseline, every other week during prehabilitation, and then 30 and 90 days after surgery. Within-person changes were estimated using linear mixed models. RESULTS 43 patients completed baseline assessments; 36(84%) completed a median 5(range 3-10) weeks of prehabilitation before surgery; 32(74%) were retained through 90-day follow-up. Baseline function was relatively low. Exercise logs show participants completed 94% of supervised exercise, 78% of prescribed IMT and 74% of home-based exercise. Between baseline and day of surgery, timed-up-and-go decreased 2.3 seconds, gait speed increased 0.1 meters/second, six-minute walk test increased 41.7 meters, and the time to complete 5 chair rises decreased 1.6 seconds(all P≤0.007). Maximum and mean inspiratory and expiratory pressures increased 4.5, 7.3, 14.1 and 13.5 centimeters of water, respectively(all P≤0.041). CONCLUSIONS Prehabilitation is feasible before major surgery and achieves clinically meaningful improvements in functional performance that may impact postoperative outcomes and recovery. These data support rationale for a larger trial powered to detect differences in postoperative outcomes.
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Affiliation(s)
- D E Hall
- Daniel E Hall, UPMC Presbyterian Hospital, Suite F12, 200 Lothrop St, Pittsburgh, PA 15213, P:412.647.0421|F:412.647.1448,
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Makita S, Yasu T, Akashi YJ, Adachi H, Izawa H, Ishihara S, Iso Y, Ohuchi H, Omiya K, Ohya Y, Okita K, Kimura Y, Koike A, Kohzuki M, Koba S, Sata M, Shimada K, Shimokawa T, Shiraishi H, Sumitomo N, Takahashi T, Takura T, Tsutsui H, Nagayama M, Hasegawa E, Fukumoto Y, Furukawa Y, Miura SI, Yasuda S, Yamada S, Yamada Y, Yumino D, Yoshida T, Adachi T, Ikegame T, Izawa KP, Ishida T, Ozasa N, Osada N, Obata H, Kakutani N, Kasahara Y, Kato M, Kamiya K, Kinugawa S, Kono Y, Kobayashi Y, Koyama T, Sase K, Sato S, Shibata T, Suzuki N, Tamaki D, Yamaoka-Tojo M, Nakanishi M, Nakane E, Nishizaki M, Higo T, Fujimi K, Honda T, Matsumoto Y, Matsumoto N, Miyawaki I, Murata M, Yagi S, Yanase M, Yamada M, Yokoyama M, Watanabe N, Itoh H, Kimura T, Kyo S, Goto Y, Nohara R, Hirata KI. JCS/JACR 2021 Guideline on Rehabilitation in Patients With Cardiovascular Disease. Circ J 2022; 87:155-235. [PMID: 36503954 DOI: 10.1253/circj.cj-22-0234] [Citation(s) in RCA: 119] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Shigeru Makita
- Department of Cardiac Rehabilitation, Saitama Medical University International Medical Center
| | - Takanori Yasu
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Hitoshi Adachi
- Department of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Hideo Izawa
- Department of Cardiology, Fujita Health University of Medicine
| | - Shunichi Ishihara
- Department of Psychology, Bunkyo University Faculty of Human Sciences
| | - Yoshitaka Iso
- Division of Cardiology, Showa University Fujigaoka Hospital
| | - Hideo Ohuchi
- Department of Pediatrics, National Cerebral and Cardiovascular Center
| | | | - Yusuke Ohya
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus
| | - Koichi Okita
- Graduate School of Lifelong Sport, Hokusho University
| | - Yutaka Kimura
- Department of Health Sciences, Kansai Medical University Hospital
| | - Akira Koike
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Masahiro Kohzuki
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine
| | - Shinji Koba
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | - Kazunori Shimada
- Department of Cardiology, Juntendo University School of Medicine
| | | | - Hirokazu Shiraishi
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Tetsuya Takahashi
- Department of Physical Therapy, Faculty of Health Science, Juntendo University
| | - Tomoyuki Takura
- Department of Healthcare Economics and Health Policy, Graduate School of Medicine, The University of Tokyo
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | | | - Emiko Hasegawa
- Faculty of Psychology and Social Welfare, Seigakuin University
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital
| | | | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Sumio Yamada
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine
| | - Yuichiro Yamada
- Center for Diabetes, Endocrinology and Metabolism, Kansai Electric Power Hospital
| | | | | | - Takuji Adachi
- Department of Physical Therapy, Nagoya University Graduate School of Medicine
| | | | | | | | - Neiko Ozasa
- Cardiovascular Medicine, Kyoto University Hospital
| | - Naohiko Osada
- Department of Physical Checking, St. Marianna University Toyoko Hospital
| | - Hiroaki Obata
- Division of Internal Medicine, Niigata Minami Hospital
- Division of Rehabilitation, Niigata Minami Hospital
| | | | - Yusuke Kasahara
- Department of Rehabilitation, St. Marianna University Yokohama Seibu Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University
| | - Shintaro Kinugawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Yuji Kono
- Department of Rehabilitation, Fujita Health University Hospital
| | - Yasuyuki Kobayashi
- Department of Medical Technology, Gunma Prefectural Cardiovascular Center
| | | | - Kazuhiro Sase
- Clinical Pharmacology and Regulatory Science, Graduate School of Medicine, Juntendo University
| | - Shinji Sato
- Department of Physical Therapy, Teikyo Heisei University
| | - Tatsuhiro Shibata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | - Norio Suzuki
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Daisuke Tamaki
- Department of Nutrition, Showa University Fujigaoka Hospital
| | - Minako Yamaoka-Tojo
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University
| | - Michio Nakanishi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Mari Nishizaki
- Department of Rehabilitation, National Hospital Organization Okayama Medical Center
| | - Taiki Higo
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Kanta Fujimi
- Department of Rehabilitation, Fukuoka University Hospital
| | - Tasuku Honda
- Department of Cardiovascular Surgery, Hyogo Brain and Heart Center
| | - Yasuharu Matsumoto
- Department of Cardiovascular Medicine, Shioya Hospital, International University of Health and Welfare
| | | | - Ikuko Miyawaki
- Department of Nursing, Kobe University Graduate School of Health Sciences
| | - Makoto Murata
- Department of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Shusuke Yagi
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | - Masanobu Yanase
- Department of Transplantation, National Cerebral and Cardiovascular Center
| | | | - Miho Yokoyama
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | | | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Syunei Kyo
- Tokyo Metropolitan Geriatric Medical Center
| | | | | | - Ken-Ichi Hirata
- Department of Internal Medicine, Kobe University Graduate School of Medicine
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Fu X, Wang Z, Wang L, Lv G, Cheng Y, Wang B, Zhang Z, Jin X, Kang Y, Zhou Y, Wu Q. Increased diaphragm echodensity correlates with postoperative pulmonary complications in patients after major abdominal surgery: a prospective observational study. BMC Pulm Med 2022; 22:400. [PMCID: PMC9636692 DOI: 10.1186/s12890-022-02194-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
Background Associated with increased morbidity and mortality, postoperative pulmonary complications (PPCs) often occur after major abdominal surgery. Diaphragmatic dysfunction is suggested to play an important role in the development of PPCs and diaphragm echodensity can be used as an indicator of diaphragm function. This study aimed to determine whether diaphragm echodensity could predict the occurrence of PPCs in patients after major abdominal surgery. Methods Diaphragm ultrasound images of patients after major abdominal surgery were collected during spontaneous breathing trials. Echodensity was quantified based on the right-skewed distribution of grayscale values (50th percentile, ED50; 85th percentile, ED85; mean, EDmean). Intra- and inter-analyzer measurement reproducibility was determined. Outcomes including occurrence of PPCs, reintubation rate, duration of ventilation, and length of ICU stay were recorded. Results Diaphragm echodensity was measured serially in 117 patients. Patients who developed PPCs exhibited a higher ED50 (35.00 vs. 26.00, p < 0.001), higher ED85 (64.00 vs. 55.00, p < 0.001) and higher EDmean (39.32 vs. 33.98, p < 0.001). In ROC curve analysis, the area under the curve of ED50 for predicting PPCs was 0.611. The optimal ED50 cutoff value for predicting the occurrence of PPCs was 36. According to this optimal ED50 cutoff value, patients were further divided into a high-risk group (ED50 > 36, n = 35) and low-risk group (ED50 ≤ 36, n = 82). Compared with the low-risk group, the high-risk group had a higher incidence of PPCs (unadjusted p = 0.003; multivariate-adjusted p < 0.001). Conclusion Diaphragm echodensity can be feasibly and reproducibly measured in mechanically ventilated patients. The increase in diaphragm echodensity during spontaneous breathing trials was related to an increased risk of PPCs in patients after major abdominal surgery. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-02194-6.
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Affiliation(s)
- Xin Fu
- grid.13291.380000 0001 0807 1581Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Zhen Wang
- grid.13291.380000 0001 0807 1581Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Luping Wang
- grid.13291.380000 0001 0807 1581Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Guangxuan Lv
- grid.13291.380000 0001 0807 1581Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yisong Cheng
- grid.13291.380000 0001 0807 1581Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Wang
- grid.13291.380000 0001 0807 1581Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Zhongwei Zhang
- grid.13291.380000 0001 0807 1581Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaodong Jin
- grid.13291.380000 0001 0807 1581Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Kang
- grid.13291.380000 0001 0807 1581Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yongfang Zhou
- grid.13291.380000 0001 0807 1581Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Qin Wu
- grid.13291.380000 0001 0807 1581Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
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Labuschagne R, Roos R. Pre-operative physiotherapy for elderly patients undergoing abdominal surgery. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2022; 78:1782. [PMID: 36262215 PMCID: PMC9575366 DOI: 10.4102/sajp.v78i1.1782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/21/2022] [Indexed: 11/01/2022] Open
Abstract
Background Elderly patients report a decrease in function and activities of daily living following abdominal surgery. The objectives of our pilot study were to determine the effects of a single pre-operative physiotherapy session consisting of education and exercise on clinical and physical function outcomes in elderly patients. Methods/design A single-blind pilot randomised controlled trial evaluated clinical and functional outcomes of elderly patients following surgery in a private hospital in Pretoria, South Africa. The outcomes included length of hospital stay (LOS), postoperative pulmonary complications (PPC), first mobilisation uptime, DeMorton Mobility Index (DEMMI), 6-minute walk test (6MWT), Lawton-Brody's instrumental activities of daily living (IADL) and the Functional Comorbidity Index (FCI). Descriptive and inferential statistics were undertaken, and statistical significance was set at p ≤ 0.05. Discussion Twelve participants (n = 11 female [91.67%] and n = 1 [8.33%] male) with a mean age of 65.75 (±4.47) years were included. Most participants (n = 10, 83.33%) underwent lower abdominal laparotomy (n = 10, 83.33%). The median hospital LOS was n = 4 (IQR 3.25-4) days; walking distance at first mobilisation was 130 m (IQR (85-225), with intervention participants walking further (intervention: 177 m, IQR 100-242.50; control: 90, IQR 60 m - 245 m; p = 0.59). Recruitment was low, with only 10.95% referrals and 47.82% nonconsents. Conclusion A single physiotherapy session prior to surgery demonstrated a potential favourable change in elderly patients' mobility postoperatively; however, further research is necessary. Clinical implication A once-off pre-operative physiotherapy session could enhance recovery in elderly patients. Trial registration Pan African Clinical Trial Registry, PACTR201809874713904, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3593.
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Affiliation(s)
- Rozelle Labuschagne
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ronel Roos
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Perioperative Exhaled Nitric Oxide as an Indicator for Postoperative Pneumonia in Surgical Lung Cancer Patients: A Prospective Cohort Study Based on 183 Cases. Can Respir J 2022; 2022:9149385. [PMID: 36106062 PMCID: PMC9464969 DOI: 10.1155/2022/9149385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 07/28/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction This study is conducted to investigate the correlation between perioperative fractional exhaled nitric oxide and postoperative pneumonia (POP) and the feasibility of perioperative FeNO for predicting POP in surgical lung cancer patients. Methods Patients who were diagnosed with non-small-cell lung cancer (NSCLC) were prospectively analyzed, and the relationship between perioperative FeNO and POP was evaluated based on patients' basic characteristics and clinical data in the hospital. Results There were 218 patients enrolled in this study. Finally, 183 patients were involved in the study, with 19 of them in the POP group and 164 in the non-POP group. The POP group had significantly higher postoperative FeNO (median: 30.0 vs. 19.0 ppb, P < 0.001) as well as change in FeNO (median: 10.0 vs. 0.0 ppb, P < 0.001) before and after the surgery. For predicting POP based on the receiver operating characteristic (ROC) curve, a cutoff value of 25 ppb for postoperative FeNO (Youden's index: 0.515, sensitivity: 78.9%, and specificity: 72.6%) and 4 ppb for change in FeNO (Youden's index: 0.610, sensitivity: 84.2%, specificity: 76.8%) were selected. Furthermore, according to the bivariate regression analysis, FEV1/FVC (OR = 0.948, 95% CI: 0.899–0.999, P=0.048), POD1 FeNO (OR = 1.048, 95% CI: 1.019–1.077, P=0.001), and change in FeNO (OR = 1.087, 95% CI: 1.044–1.132, P < 0.001) were significantly associated with occurrence of POP. Conclusions This prospective study revealed that a high postoperative FeNO (>25 ppb), as well as an increased change in FeNO (>4 ppb), may have the potential in detecting the occurrence of POP in surgical lung cancer patients.
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Effectiveness of Preoperative Chest Physiotherapy in Patients Undergoing Elective Cardiac Surgery, a Systematic Review and Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58070911. [PMID: 35888629 PMCID: PMC9319848 DOI: 10.3390/medicina58070911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/29/2022] [Accepted: 07/05/2022] [Indexed: 12/02/2022]
Abstract
Background and Objectives: Patients undergoing cardiac surgery are particularly vulnerable for developing postoperative pulmonary complications (PPCs). This systematic review and meta-analysis aimed to evaluate the role of preoperative chest physiotherapy in such patients. Materials and Methods: All original articles that assessed patients undergoing elective cardiac surgery, with preoperative chest physiotherapy, and compared them to patients undergoing elective cardiac surgery, without preoperative chest physiotherapy, were included. Animal studies, studies conducted prior to the year 2000, commentaries, or general discussion papers whose authors did not present original data were excluded. Studies assessing physiotherapy regimens other than chest physiotherapy were also excluded. The search was performed using the following electronic resources: the Cochrane Central Register of Controlled Trials, the PubMed central database, and Embase. The included studies were assessed for potential bias using the Cochrane Collaboration’s tool for assessing the risk of bias. Each article was read carefully, and any relevant data were extracted. The extracted data were registered, tabulated, and analyzed using Review Manager software. Results: A total of 10 articles investigating 1458 patients were included in the study. The studies were published from 2006 to 2019. The populations were patients scheduled for elective CABG/cardiac surgery, and they were classified into two groups: the interventional (I) group, involving 651 patients, and the control (C) group, involving 807 patients. The meta-analysis demonstrated no significant differences between the interventional and control groups in surgery time and ICU duration, but a significant difference was found in the time of mechanical ventilation and the length of hospital stay, favoring the interventional group. A significant difference was shown in the forced expiratory volume in 1s (FEV1% predicted), forced vital capacity (FVC% predicted), and maximum inspiratory pressure (Pi-max), favoring the interventional group. Conclusions: This study is limited by the fact that one of the included ten studies was not an RCT. Moreover, due to lack of the assessment of certain variables in some studies, the highest number of studies included in a meta-analysis was the hospital stay length (eight studies), and the other variables were analyzed in a fewer number of studies. The data obtained can be considered as initial results until more inclusive RCTs are conducted involving a larger meta-analysis. However, in the present study, the intervention was proved to be protective against the occurrence of PPCs. The current work concluded that preoperative chest physiotherapy can yield better outcomes in patients undergoing elective cardiac surgery.
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