RT Journal
A1 Hulzebos EJ, Helders PM, Favié NJ, De Bie RA, Brutel de la Riviere A, Van Meeteren NU
T1 Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing cabg surgery: A randomized clinical trial
JF JAMA
JO JAMA
YR 2006
FD October 18
VO 296
IS 15
SP 1851
OP 1857
DO 10.1001/jama.296.15.1851
UL http://dx.doi.org/10.1001/jama.296.15.1851
AB Context 
                  Postoperative pulmonary complications (PPCs) after coronary artery bypass graft (CABG) surgery are a major source of morbidity and mortality, and increase length of hospital stay and resource utilization. The prehospitalization period before CABG surgery may be used to improve a patient's pulmonary condition. The efficacy of preoperative inspiratory muscle training (IMT) in reducing the incidence of PPCs in high-risk patients undergoing CABG surgery has not yet been determined.Objective 
                  To evaluate the prophylactic efficacy of preoperative IMT on the incidence of PPCs in high-risk patients scheduled for elective CABG surgery.Design, Setting, and Patients 
                  A single-blind, randomized clinical trial conducted at the University Medical Center Utrecht, Utrecht, the Netherlands, with enrollment between July 2002 and August 2005. Of 655 patients referred for elective CABG surgery, 299 (45.6%) met criteria for high risk of developing PPCs, of whom 279 were enrolled and followed up until discharge from hospital.Intervention 
                  Patients were randomly assigned to receive either preoperative IMT (n = 140) or usual care (n = 139). Both groups received the same postoperative physical therapy.Main Outcome Measures 
                  Incidence of PPCs, especially pneumonia, and duration of postoperative hospitalization.Results 
                  Both groups were comparable at baseline. After CABG surgery, PPCs were present in 25 (18.0%) of 139 patients in the IMT group and 48 (35.0%) of 137 patients in the usual care group (odds ratio [OR], 0.52; 95% confidence interval [CI], 0.30-0.92). Pneumonia occurred in 9 (6.5%) of 139 patients in the IMT group and in 22 (16.1%) of 137 patients in the usual care group (OR, 0.40; 95% CI, 0.19-0.84). Median duration of postoperative hospitalization was 7 days (range, 5-41 days) in the IMT group vs 8 days (range, 6-70 days) in the usual care group by Mann-Whitney U statistic (z = –2.42; P = .02).Conclusion 
                  Preoperative IMT reduced the incidence of PPCs and duration of postoperative hospitalization in patients at high risk of developing a pulmonary complication undergoing CABG surgery.Trial Registration 
                  isrctn.org Identifier: ISRCTN17691887