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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, de Faria Rosseto S, Lúcio Vaz J, de Faria Cordeiro Alves C, Vidigal FDC, Galdino G. Evaluation of respiratory and peripheral muscle training in individuals undergoing myocardial revascularization. J Card Surg 2021; 36:3166-3173. [PMID: 34085324 DOI: 10.1111/jocs.15698] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate the effect of peripheral muscle strength training (PMT) and respiratory muscle strength training (RMT) muscle strength training associated with conventional physical therapy on the respiratory muscle strength, functional capacity, and quality of life in the immediate postoperative period of patients undergoing coronary artery bypass graft (CABG). METHODS This was a randomized controlled trial. Eighty-three patients undergoing CABG were divided into two groups: Intervention group, patients that received PMT and RMT associated with conventional physical therapy, one session a day for 5 days; control group, patients that received conventional physical therapy, one session a day for 5 days. All patients had respiratory muscle strength, peripheral muscle strength, functional capacity, and quality of life evaluated by manovacuometry, dynamometry, 6-min walking test, and 36-item Short-Form Health Survey Questionnaire, respectively, before and 5 days after CABG. RESULTS Both groups showed a significantly reduced respiratory muscle strength after CABG; however, in the intervention group, the inspiratory muscle strength reduction was lower (confidence interval [CI] 95%: 2.29 [1.9; 27.54]). The quality of live domains for pain (CI 95%: 3.08 [5.21; 24.97]) and vitality perception (CI 95%: 2.51 [2.12; 19.53]) worsened in the control and improved in the intervention group (pain: CI 95%: 1.19 [-3.38; 13.09]; vitality CI 95%: 0.07 [-6.55; 7.04]). Both groups showed reduced functional capacity and expiratory muscle strength after CABG. CONCLUSION Conventional physical therapy combined with PMT and RMT may reduce inspiratory muscle strength loss and improve pain and vitality perception in the immediate postoperative period after CABG.
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Affiliation(s)
- Tarcísio Nema de Aquino
- Department of Motricity Sciences, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil.,Department of Rehabilitation and Cardiology of Hospital Santa Lucia, Poços de Caldas, Minas Gerais, Brazil
| | - Simone de Faria Rosseto
- Department of Motricity Sciences, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil.,Department of Rehabilitation and Cardiology of Hospital Santa Lucia, Poços de Caldas, Minas Gerais, Brazil
| | - Jaqueline Lúcio Vaz
- Department of Motricity Sciences, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil.,Department of Rehabilitation and Cardiology of Hospital Santa Lucia, Poços de Caldas, Minas Gerais, Brazil
| | | | | | - Giovane Galdino
- Department of Motricity Sciences, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil
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Maruyama S, Okamura A, Ishizuka N, Kanie Y, Sakamoto K, Fujiwara D, Kanamori J, Imamura Y, Watanabe M. Airflow Limitation Predicts Postoperative Pneumonia after Esophagectomy. World J Surg 2021; 45:2492-2500. [PMID: 33939012 DOI: 10.1007/s00268-021-06148-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is known to be a risk factor of pneumonia after esophagectomy. In this study, we investigated the relationship of airflow limitation with the occurrence and the severity of pneumonia in esophageal cancer patients who underwent esophagectomy. METHODS We enrolled 844 patients who underwent curative esophagectomy between 2009 and 2018. The airflow limitation was evaluated using the percent-predicted forced expiratory volume at 1 s (%FEV1) with spirometry. RESULTS There were 597 (70.7%), 141 (16.7%), 68 (8.1%), and 38 patients (4.5%) with %FEV1 of ≥ 90%, 80-90%, 70-80%, and < 70% categories, respectively. One hundred and ninety-one patients (22.6%) occurred pneumonia, and the incidences of pneumonia in each category of patients were 18.8%, 28.4%, 29.4%, and 50.0%, respectively. In multivariate analysis, the categories of 80%-90%, 70-80%, and < 70% were significantly associated with a higher incidence of postoperative pneumonia (OR 1.57; 95% CI 1.02-2.43, OR 1.87; 95% CI 1.04-3.36, OR 3.34; 95% CI 1.66-6.71, respectively), with the %FEV1 category of ≥ 90% as reference. The incidence of severe pneumonia of Clavien-Dindo grade III or higher was also significantly associated with the %FEV1. In patients without COPD, the incidence of pneumonia was significantly higher in those with %FEV1 < 90% than in those with %FEV1 ≥ 90% (32.2% versus 17.5%, p < 0.001). CONCLUSIONS The airflow limitation can help predict the occurrence of pneumonia after esophagectomy in patients with and without COPD. Exclusive preventive measures should be considered in patients with reduced %FEV1 undergoing esophagectomy.
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Affiliation(s)
- Suguru Maruyama
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Akihiko Okamura
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan.
| | - Naoki Ishizuka
- Department of Clinical Trial Planning and Management, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yasukazu Kanie
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Kei Sakamoto
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Daisuke Fujiwara
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Jun Kanamori
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Yu Imamura
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Masayuki Watanabe
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
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4
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Yoshida N, Harada K, Iwatsuki M, Baba Y, Baba H. Precautions for avoiding pulmonary morbidity after esophagectomy. Ann Gastroenterol Surg 2020; 4:480-484. [PMID: 33005841 PMCID: PMC7511556 DOI: 10.1002/ags3.12354] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 04/27/2020] [Accepted: 05/12/2020] [Indexed: 12/15/2022] Open
Abstract
Pulmonary morbidity is the most common complication after esophagectomy. Importantly, it is the main cause of surgery-related mortality and possibly adversely affects the long-term outcome after surgery in patients with esophageal cancer. There is considerable accumulated evidence on multidisciplinary approaches to reduce post-operative pulmonary morbidity. A comprehensive review of the precautionary measures that have so far been shown to be effective in previous literature is of utmost importance. We herein update and summarize the perioperative and surgical approaches to diminish pulmonary morbidity. Pre-operative smoking cessation, respiratory rehabilitation, maintaining oral hygiene, perioperative nutritional intervention, enforcement of less invasive surgery, perioperative administration of steroid, and total management by a multidisciplinary team could be the key factors contributing to reduction in pulmonary morbidity.
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Affiliation(s)
- Naoya Yoshida
- Department of Gastroenterological SurgeryGraduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Kazuto Harada
- Department of Gastroenterological SurgeryGraduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Masaaki Iwatsuki
- Department of Gastroenterological SurgeryGraduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Yoshifumi Baba
- Department of Gastroenterological SurgeryGraduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Hideo Baba
- Department of Gastroenterological SurgeryGraduate School of Medical SciencesKumamoto UniversityKumamotoJapan
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Critical appraisal on the impact of preoperative rehabilitation and outcomes after major abdominal and cardiothoracic surgery: A systematic review and meta-analysis. Surgery 2020; 167:540-549. [DOI: 10.1016/j.surg.2019.07.032] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/15/2019] [Accepted: 07/29/2019] [Indexed: 12/26/2022]
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6
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Santos SC, Fréz AR, Ruaro JA, Wouk J, Daniel CR. Risk factors and postoperative complications in oncologic surgeries. FISIOTERAPIA EM MOVIMENTO 2020. [DOI: 10.1590/1980-5918.033.ao53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract Introduction: Oncological patients who are submitted to surgical procedures might have postoperative pulmonary complications (PPCs). Thus, preoperative physical conditions must be considered, since it is an important predictor of postoperative development. Objective: The purpose of this study was to analyze the risk factors for postoperative pulmonary complications that might compromise the recovery after oncologic surgery. Method: The present observational transversal study was made between March and October of 2015. Patients diagnosed with cancer were analyzed to determine pulmonary and functional condition and to identify the risk factors for the development of PPCs. The post-surgery recovery was followed through medical records. Data collected from patients’ analyses was correlated with post-surgery development. Results: Thirty patients were analyzed. A negative and moderate correlation was found between maximal inspiratory pressure (MIP) and PPCs (r=-0.39; p=0.032). A positive correlation between the time of permanence in the Intensive Care Unit (ICU) and hospitalization days (r=0.40; p=0.02) was observed. Correlations between PPCs and mechanical ventilation (r=0.36; p=0.04) and hospitalization days (r=0.40; p=0.02) were also noticed in the present study. Conclusion: PPCs might prejudice post-surgery outcome. The greater are physical condition and pulmonary functions of the patients before surgery, the better is their recovery.
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7
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Tosta ADM, Borges MDC, Silva ÉMCD, Takeuti TD, Terra Júnior JA, Crema E. Pulmonary function evaluation in type 2 diabetes mellitus patients submitted to metabolic surgery. FISIOTERAPIA EM MOVIMENTO 2018. [DOI: 10.1590/1980-5918.031.ao20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Diabetes Mellitus (DM) is a multifactorial metabolic disorder. As considered a public health problem needing additional treatment options. Objective: This prospective study aimed at evaluating pulmonary function through spirometry, before and after metabolic surgery without gastric resection in type 2 DM patients. Methods: Sample was composed by 17 type 2 DM females. They were analyzed in pre (24 hours before surgical procedure), immediate post-operative period POST1 (24 hours after surgical procedure) and in the late postoperative period POST2 (two years after surgical procedure). Besides statistical analysis, it was evaluated the following spirometric parameters: forced vital capacity (FVC), forced expiratory volume in the first second (FEV1) and the FEV1 / FVC ratio (%). Results: Spirometric parameters showed a value increase when compared PRE and POS2 values, except for FVC and FEV1, which was not statistically significant. Conclusion: Type 2 DM women submitted to metabolic surgery without gastric resection showed spirometric value increased after two-year surgical procedure, when compared to preoperative period values. It is important additional studies about pulmonary function, diabetic patients and metabolic surgery without gastric resection.
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Agrelli TF, Borges MDC, Cunha FMRD, Silva ÉMCD, Terra Júnior JA, Crema E. Combination of preoperative pulmonary and nutritional preparation for esophagectomy. Acta Cir Bras 2018; 33:67-74. [PMID: 29412234 DOI: 10.1590/s0102-865020180010000007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 12/20/2017] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To compare pulmonary and nutritional parameters before and after inspiratory muscle training (IMT) and enteral feeding support in patients with esophageal disease undergoing preoperative outpatient follow-up. METHODS Thirty patients with a mean age of 55.83 years, 16 men and 14 women, were included. Pulmonary assessment consisted of the measurement of MIP, MEP, and spirometry. Anthropometric measurements and laboratory tests were performed for nutritional assessment. After preoperative evaluation, inspiratory muscle training and enteral nutrition support were started. A p<0.05 was considered statistically significant. RESULTS After an outpatient follow-up period of 4 weeks, a significant increase in MIP (-62.20 ± 25.78 to -81.53 ± 23.09), MEP (73.4 ± 31.95 to 90.33 ± 28.39), and FVC (94.86 ± 16.77 to 98.56 ± 17.44) was observed. Regarding the anthropometric variables, a significant increase was also observed in BMI (20.18 ± 5.04 to 20.40 ± 4.69), arm circumference (23.38 ± 3.28 to 25.08 ± 4.55), arm muscle circumference (21.48 ± 3.00 to 22.07 ± 3.36), and triceps skinfold thickness (5.62 ± 2.68 to 8.33 ± 6.59). CONCLUSION Pulmonary and nutritional preparation can improve respiratory muscle strength, FVC and anthropometric parameters. However, further studies are needed to confirm the effectiveness of this preoperative preparation.
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Affiliation(s)
- Taciana Freitas Agrelli
- PhD, Physiotherapist, Department of Surgery, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba-MG, Brazil. Intellectual and scientific content of the study, manuscript writing, critical revision
| | - Marisa de Carvalho Borges
- PhD, Physiotherapist, Department of Surgery, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba-MG, Brazil. Intellectual and scientific content of the study, manuscript writing, critical revision
| | - Fernanda Maria Rodrigues da Cunha
- MSc, Physiotherapist, Department of Surgery, UFTM, Uberaba-MG, Brazil. Intellectual and scientific content of the study, manuscript writing, critical revision
| | - Élida Mara Carneiro da Silva
- PhD, Physiotherapist, Department of Surgery, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba-MG, Brazil. Intellectual and scientific content of the study, manuscript writing, critical revision
| | - Júverson Alves Terra Júnior
- PhD, Full Professor, Department of Surgery, UFTM, Uberaba-MG, Brazil. Scientific content of the study, technical procedures, critical revision
| | - Eduardo Crema
- PhD, Full Professor, Department of Surgery, UFTM, Uberaba-MG, Brazil. Scientific content of the study, technical procedures, critical revision
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9
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Valkenet K, Trappenburg JCA, Ruurda JP, Guinan EM, Reynolds JV, Nafteux P, Fontaine M, Rodrigo HE, van der Peet DL, Hania SW, Sosef MN, Willms J, Rosman C, Pieters H, Scheepers JJG, Faber T, Kouwenhoven EA, Tinselboer M, Räsänen J, Ryynänen H, Gosselink R, van Hillegersberg R, Backx FJG. Multicentre randomized clinical trial of inspiratory muscle training versus usual care before surgery for oesophageal cancer. Br J Surg 2018; 105:502-511. [DOI: 10.1002/bjs.10803] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/12/2017] [Accepted: 11/27/2017] [Indexed: 01/22/2023]
Abstract
Abstract
Background
Up to 40 per cent of patients undergoing oesophagectomy develop pneumonia. The aim of this study was to assess whether preoperative inspiratory muscle training (IMT) reduces the rate of pneumonia after oesophagectomy.
Methods
Patients with oesophageal cancer were randomized to a home-based IMT programme before surgery or usual care. IMT included the use of a flow-resistive inspiratory loading device, and patients were instructed to train twice a day at high intensity (more than 60 per cent of maximum inspiratory muscle strength) for 2 weeks or longer until surgery. The primary outcome was postoperative pneumonia; secondary outcomes were inspiratory muscle function, lung function, postoperative complications, duration of mechanical ventilation, length of hospital stay and physical functioning.
Results
Postoperative pneumonia was diagnosed in 47 (39·2 per cent) of 120 patients in the IMT group and in 43 (35·5 per cent) of 121 patients in the control group (relative risk 1·10, 95 per cent c.i. 0·79 to 1·53; P = 0·561). There was no statistically significant difference in postoperative outcomes between the groups. Mean(s.d.) maximal inspiratory muscle strength increased from 76·2(26·4) to 89·0(29·4) cmH2O (P < 0·001) in the intervention group and from 74·0(30·2) to 80·0(30·1) cmH2O in the control group (P < 0·001). Preoperative inspiratory muscle endurance increased from 4 min 14 s to 7 min 17 s in the intervention group (P < 0·001) and from 4 min 20 s to 5 min 5 s in the control group (P = 0·007). The increases were highest in the intervention group (P < 0·050).
Conclusion
Despite an increase in preoperative inspiratory muscle function, home-based preoperative IMT did not lead to a decreased rate of pneumonia after oesophagectomy. Registration number: NCT01893008 (https://www.clinicaltrials.gov).
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Affiliation(s)
- K Valkenet
- Department of Rehabilitation, Physiotherapy Science and Sports, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - J C A Trappenburg
- Department of Rehabilitation, Physiotherapy Science and Sports, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - J P Ruurda
- Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - E M Guinan
- Discipline of Physiotherapy, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Ireland
| | - J V Reynolds
- Department of Surgery, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Ireland
| | - P Nafteux
- Department of Surgery, University Hospitals Leuven, Leuven, Belgium
| | - M Fontaine
- Department of Physiotherapy, University Hospitals Leuven, Leuven, Belgium
| | - H E Rodrigo
- Department of Rehabilitation, Physiotherapy Science and Sports, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - D L van der Peet
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands
| | - S W Hania
- Department of Physiotherapy, VU University Medical Centre, Amsterdam, The Netherlands
| | - M N Sosef
- Department of Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - J Willms
- Department of Physiotherapy, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - C Rosman
- Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - H Pieters
- Department of Physiotherapy, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - J J G Scheepers
- Department of Surgery, Reinier de Graaf Hospital, Delft, The Netherlands
| | - T Faber
- Department of Physiotherapy, Reinier de Graaf Hospital, Delft, The Netherlands
| | - E A Kouwenhoven
- Department of Surgery, Hospital Group Twente, Almelo, The Netherlands
| | - M Tinselboer
- Department of Physiotherapy, Hospital Group Twente, Almelo, The Netherlands
| | - J Räsänen
- Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland
| | - H Ryynänen
- Department of Physiotherapy, Helsinki University Central Hospital, Helsinki, Finland
| | - R Gosselink
- Rehabilitation Sciences, University Hospitals Leuven, Leuven, Belgium
| | - R van Hillegersberg
- Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - F J G Backx
- Department of Rehabilitation, Physiotherapy Science and Sports, University Medical Centre Utrecht, Utrecht, The Netherlands
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10
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Risk factors for pulmonary morbidities after minimally invasive esophagectomy for esophageal cancer. Surg Endosc 2017; 32:2852-2858. [DOI: 10.1007/s00464-017-5993-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 12/02/2017] [Indexed: 02/07/2023]
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11
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Borges MDC, Takeuti TD, Terra JA, Silva AAD, Crema E. Comparative study of respiratory muscle strength in women undergoing conventional and single-port laparoscopic cholecystectomy. Acta Cir Bras 2017; 32:881-890. [PMID: 29160375 DOI: 10.1590/s0102-865020170100000010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 09/18/2017] [Indexed: 01/24/2023] Open
Abstract
PURPOSE To evaluate respiratory muscle strength (PImax and PEmax) before and 24 and 48 h after conventional and single-port laparoscopic cholecystectomy. METHODS Forty women with symptomatic cholelithiasis (18 to 70 years) participated in the study. The patients were divided into two groups: 21 patients undergoing conventional laparoscopic cholecystectomy and 19 patients undergoing single-port laparoscopic cholecystectomy. Differences were considered to be significant when p<0.05. RESULTS The results showed a greater decline in PImax after 24 h in the group submitted to conventional laparoscopic cholecystectomy, with a significant difference between groups (p=0.0308). CONCLUSION Recovery of the parameters studied was more satisfactory and respiratory muscle strength was less compromised in the group submitted to single-port laparoscopic cholecystectomy.
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Affiliation(s)
- Marisa de Carvalho Borges
- PhD, Physiotherapist, Department of Surgery, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba-MG, Brazil. Intellectual and scientific content of the study, manuscript writing, critical revision
| | - Tharsus Dias Takeuti
- PhD of Health Sciences, Department of Surgery, UFTM, Uberaba-MG, Brazil. Intellectual and scientific content of the study, manuscript writing, critical revision
| | - Júverson Alves Terra
- PhD, Full Professor, Department of Surgery, UFTM, Uberaba-MG, Brazil. Scientific content of the study, technical procedures, critical revision
| | - Alex Augusto da Silva
- PhD, Full Professor, Department of Surgery, UFTM, Uberaba-MG, Brazil. Scientific content of the study, technical procedures, critical revision
| | - Eduardo Crema
- PhD, Full Professor, Department of Surgery, UFTM, Uberaba-MG, Brazil. Scientific content of the study, technical procedures, critical revision
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Abdullah HR, Lien VP, Ong HK, Er PL, Hao Y, Khan SA, Liu CW. Protocol for a single-centre, randomised controlled study of a preoperative rehabilitation bundle in the frail and elderly undergoing abdominal surgery. BMJ Open 2017; 7:e016815. [PMID: 28778994 PMCID: PMC5629626 DOI: 10.1136/bmjopen-2017-016815] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 06/21/2017] [Accepted: 06/23/2017] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Frail patients have decreased physiological reserves and consequently, they are unable to recover as quickly from surgery. Frailty, as an entity, is a risk factor of increased morbidity and mortality. It is also associated with a longer time to discharge. This trial is undertaken to determine if a novel prehabilitation protocol (10-day bundle of interventions-physiotherapy, nutritional supplementation and cognitive training) can reduce the postoperative length of stay of frail patients who are undergoing elective abdominal surgery, compared with standard care. METHODS AND ANALYSIS This is a prospective, single-centre, randomised controlled trial with two parallel arms. 62 patients who are frail and undergoing elective abdominal surgery will be recruited and randomised to receive either a novel prehabilitation protocol or standard care. Participants will receive telephone reminders preoperatively to encourage protocol compliance. Data will be collected for up to 30 days postoperatively. The primary outcome of the trial will be the postoperative length of stay and the secondary outcomes are the postoperative complications and functional recovery during the hospital admission. ETHICS AND DISSEMINATION This study has been approved by the Singapore General Hospital Institutional Review Board (CIRB Ref: 2016/2584). The study is also listed on ClinicalTrials.gov (Trial number: NCT02921932). All participants will sign an informed consent form before randomisation and translators will be made available to non-English speaking patients. The results of this study will be published in peer-reviewed journals as well as national and international conferences. The data collected will also be made available in a public data repository. TRIAL REGISTRATION NUMBER NCT02921932 (ClinicalTrials.gov).
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Affiliation(s)
- Hairil Rizal Abdullah
- Department of Anesthesiology, Singapore General Hospital, Singapore, Singapore
- DukeNUS Medical School, Singapore, Singapore
| | | | - Hwee Kuan Ong
- Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore
- Singapore Institute of Technology, Singapore, Singapore
| | - Pei Ling Er
- Department of Dietetics, Singapore General Hospital, Singapore, Singapore
| | - Ying Hao
- Health Services Research Unit, Singapore General Hospital, Singapore, Singapore
| | - Shariq Ali Khan
- Department of Anesthesiology, Singapore General Hospital, Singapore, Singapore
- DukeNUS Medical School, Singapore, Singapore
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13
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Pfirrmann D, Tug S, Brosteanu O, Mehdorn M, Busse M, Grimminger PP, Lordick F, Glatz T, Hoeppner J, Lang H, Simon P, Gockel I. Internet-based perioperative exercise program in patients with Barrett's carcinoma scheduled for esophagectomy [iPEP - study] a prospective randomized-controlled trial. BMC Cancer 2017; 17:413. [PMID: 28615010 PMCID: PMC5471695 DOI: 10.1186/s12885-017-3400-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 06/01/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Patients undergoing surgery for esophageal cancer have a high risk for postoperative deterioration of lung function and pulmonary complications. This is partly due to one-lung ventilation during thoracotomy. This often accounts for prolonged stay on intensive care units, delayed postoperative reconvalescence and reduced quality of life. Socioeconomic disadvantages can result from these problems. Physical preconditioning has become a crucial leverage to optimize fitness and lung function in patients scheduled for esophagectomy, in particular during the time period of neoadjuvant therapy. METHODS/STUDY DESIGN We designed a prospective multicenter randomized-controlled trial. The objective is to evaluate the impact of an internet-based exercise program on postoperative respiratory parameters and pneumonia rates in patients with Barrett's carcinoma scheduled for esophagectomy. Patients are randomly assigned to either execute internet-based perioperative exercise program (iPEP), including daily endurance, resistance and ventilation training or treatment as usual (TAU). During neoadjuvant therapy and recovery, patients in the intervention group receive an individually designed intensive exercise program based on functional measurements at baseline. Personal feedback of the supervisor with customized training programs is provided in weekly intervals. DISCUSSION This study will evaluate if an intensive individually adapted training program via online supervision during neoadjuvant therapy will improve cardiorespiratory fitness and reduce pulmonary complications following esophagectomy for Barrett's cancer. TRIAL REGISTRATION NCT02478996 , registered 26 May 2015.
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Affiliation(s)
- Daniel Pfirrmann
- Department of Sports Medicine, Disease Prevention and Rehabilitation, Johannes Gutenberg-University of Mainz, Albert-Schweitzer-Str. 22, D-55128 Mainz, Germany
| | - Suzan Tug
- Department of Sports Medicine, Disease Prevention and Rehabilitation, Johannes Gutenberg-University of Mainz, Albert-Schweitzer-Str. 22, D-55128 Mainz, Germany
| | - Oana Brosteanu
- Clinical Trial Centre Leipzig, University Leipzig, Leipzig, Germany
| | - Matthias Mehdorn
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Martin Busse
- Institute for Sports Medicine and Prevention, University of Leipzig, Leipzig, Germany
| | - Peter P. Grimminger
- Department of General, Visceral and Transplant Surgery, University Hospital of Mainz, Mainz, Germany
| | - Florian Lordick
- University Cancer Centre Leipzig, University Medicine Leipzig, Leipzig, Germany
| | - Torben Glatz
- Department of General and Visceral Surgery Medical Centre, University of Freiburg, Freiburg, Germany
| | - Jens Hoeppner
- Department of General and Visceral Surgery Medical Centre, University of Freiburg, Freiburg, Germany
| | - Hauke Lang
- Department of General, Visceral and Transplant Surgery, University Hospital of Mainz, Mainz, Germany
| | - Perikles Simon
- Department of Sports Medicine, Disease Prevention and Rehabilitation, Johannes Gutenberg-University of Mainz, Albert-Schweitzer-Str. 22, D-55128 Mainz, Germany
| | - Ines Gockel
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Leipzig, Germany
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14
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Goense L, van Dijk WA, Govaert JA, van Rossum PSN, Ruurda JP, van Hillegersberg R. Hospital costs of complications after esophagectomy for cancer. Eur J Surg Oncol 2016; 43:696-702. [PMID: 28012715 DOI: 10.1016/j.ejso.2016.11.013] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 11/15/2016] [Accepted: 11/21/2016] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The purpose of this study was to estimate the economic burden of postoperative complications after esophagectomy for cancer, in order to optimally allocate resources for quality improvement initiatives in the future. METHODS A retrospective analysis of prospectively collected clinical and financial outcomes after esophageal cancer surgery in a tertiary referral center in the Netherlands was performed. Data was extracted from consecutive patients registered in the Dutch Upper GI Cancer Audit between 2011 and 2014 (n = 201). Costs were measured up to 90-days after hospital discharge and based on Time-Driven Activity-Based Costing. The additional costs were estimated using multiple linear regression models. RESULTS The average total cost for one patient after esophagectomy was €37,581 (±31,372). The estimated costs of an esophagectomy without complications were €23,476 (±6496). Mean costs after minor (47%) and severe complications (29%) were €31,529 (±23,359) and €59,167 (±42,615) (p < 0.001), respectively. The 5% most expensive patients were responsible for 20.3% of the total hospital costs assessed in this study. Patient characteristics associated with additional costs in multivariable analysis included, age >70 (+€2,922, p = 0.036), female gender (+€4,357, p = 0.005), COPD (+€5,415, p = 0.002), and a history of thromboembolic events (+€6,213, p = 0.028). Complications associated with a significant increase in costs in multivariable analysis included anastomotic leakage (+€4,123, p = 0.008), cardiac complications (+€5,711, p = 0.003), chyle leakage (+€6,188, p < 0.001) and postoperative bleeding (+€31,567, p < 0.001). CONCLUSIONS Complications and severity of complications after esophageal surgery are associated with a substantial increase in costs. Although not all postoperative complications can be prevented, implementation of preventive measures to reduce complications could result in a considerable cost reduction and quality improvement.
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Affiliation(s)
- L Goense
- Department of Surgery, University Medical Center Utrecht, The Netherlands; Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands.
| | | | - J A Govaert
- Department of Surgery, Leiden University Medical Center, The Netherlands
| | - P S N van Rossum
- Department of Surgery, University Medical Center Utrecht, The Netherlands; Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands
| | - J P Ruurda
- Department of Surgery, University Medical Center Utrecht, The Netherlands
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Abstract
Recent studies could demonstrate that neoadjuvant chemotherapy and radiochemotherapy for esophageal and gastric cancer do not significantly increase the risk of postoperative morbidity and mortality as compared to surgery alone. With respect to patient safety and effectiveness of neoadjuvant concepts, quality assured performance of each treatment modality and close interdisciplinary cooperation play an important role. The majority of potential side effects and complications, which might occur during neoadjuvant therapy can be adequately controlled by correct prophylaxis and professional medical complication management. Complications before, during and after neoadjuvant therapy of upper gastrointestinal tract tumors can also be caused by the tumor itself or by medicinal therapy. These comprise bleeding, fistulas, perforations and stenoses. Modern endoscopic techniques are the therapy of choice in these situations. Preoperative conditioning during the period of neoadjuvant therapy opens the possibility of reduced postoperative complications to patients with tumors of the upper gastrointestinal tract.
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16
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Lordick F, Gockel I. Chances, risks and limitations of neoadjuvant therapy in surgical oncology. Innov Surg Sci 2016; 1:3-11. [PMID: 31579713 PMCID: PMC6753981 DOI: 10.1515/iss-2016-0004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 07/04/2016] [Indexed: 01/19/2023] Open
Abstract
Over the last decades, neoadjuvant treatment has been established as a standard of care for a variety of tumor types in visceral oncology. Neoadjuvant treatment is recommended in locally advanced esophageal and gastric cancer as well as in rectal cancer. In borderline resectable pancreatic cancer, neoadjuvant therapy is an emerging treatment concept, whereas in resectable colorectal liver metastases, neoadjuvant treatment is often used, although the evidence for improvement of survival outcomes is rather weak. What makes neoadjuvant treatment attractive from a surgical oncology viewpoint is its ability to shrink tumors to a smaller size and to increase the chances for complete resection with clear surgical margins, which is a prerequisite for cure. Studies suggest that local tumor control is increased in some visceral tumor types, especially with neoadjuvant chemoradiotherapy. In some other studies, a better control of systemic disease has contributed to significantly improved survival rates. Additionally, delaying surgery offers the chance to bring the patient into a better general condition for major surgery, but it also confers the risk of progression. Although it is a relatively rare event, cancers may progress locally during neoadjuvant treatment or distant metastases may occur, jeopardizing a curative surgical treatment approach. Although this is seen as risk of neoadjuvant treatment, it can also be seen as a chance to select only those patients for surgery who have a better control of systemic disease. Some studies showed increased perioperative morbidity in patients who underwent neoadjuvant treatment, which is another potential disadvantage. Optimal multidisciplinary teamwork is key to controlling that risk. Meanwhile, the neoadjuvant treatment period is also used as a "window of opportunity" for studying the activity of novel drugs and for investigating predictive and prognostic biomarkers of chemoradiotherapy and radiochemotherapy. Although the benefits of neoadjuvant treatment have been clearly established, the risk of overtreatment of cancers with an unfavorable prognosis remains an issue. All indications for neoadjuvant treatment are based on clinical staging. Even if staging is done meticulously, making use of all recommended diagnostic modalities, the risk of overstaging and understaging remains considerable and may lead to false indications for neoadjuvant treatment. Finally, despite all developments and emerging concepts in medical oncology, many cancers remain resistant to the currently available drugs and radiation. This may in part be due to specific molecular resistance mechanisms that are marginally understood thus far. Neoadjuvant treatment has been one of the major advances in multidisciplinary oncology in the last decades, requiring a dedicated treatment team and an optimal infrastructure for complex oncology care. This article discusses the goals and novel directions as well as limitations in neoadjuvant treatment of visceral cancers.
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Affiliation(s)
- Florian Lordick
- University Cancer Center Leipzig (UCCL), University Hospital Leipzig, Liebigstr. 20, Leipzig 04103, Germany
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Medicine Leipzig, Leipzig, Germany
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17
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Predictive Effects of Lung function test on Postoperative Pneumonia in Squamous Esophageal Cancer. Sci Rep 2016; 6:23636. [PMID: 27004739 PMCID: PMC4804297 DOI: 10.1038/srep23636] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 03/10/2016] [Indexed: 11/17/2022] Open
Abstract
Pulmonary function tests had prospective implications for postoperative pneumonia, which occurred frequently after esophagectomy. Understanding factors that were associated with pulmonary infection may help in patient selection and postoperative management. We performed a retrospective review of 2 independent cohorts including 216 patients who underwent esophagectomy between November 2011 and May 2014, aiming at identifying predictors of primary pneumonia. Univariate analysis was used to identify potential covariates for the development of primary pneumonia. Adjustments for multiple comparisons were made using False Discovery Rate (FDR) (Holm-Bonferroni method). Multivariable logistic regression analysis was used to identify independent predictors and construct a regression model based on a training cohort (n = 166) and then the regression model was validated using an independent cohort (n = 50). It showed that low PEF (hazard ratio 0.97, P = 0.009) was independent risk factors for the development of primary pneumonia in multivariate analyses and had a predictive effect for primary pneumonia (AUC = 0.691 and 0.851 for training and validation data set, respectively). Therefore, PEF has clinical value in predicting postoperative pneumonia after esophagectomy and it may serve as an indicator of preoperative lung function training.
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18
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Non-ventilatory approaches to prevent postoperative pulmonary complications. Best Pract Res Clin Anaesthesiol 2015; 29:397-410. [PMID: 26643103 DOI: 10.1016/j.bpa.2015.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/27/2015] [Accepted: 08/28/2015] [Indexed: 02/07/2023]
Abstract
This educational narrative review provides a summary of non-ventilatory strategies to prevent postoperative pulmonary complications (PPCs). It highlights patient- and procedure-related risk factors for PPCs that are non-modifiable, potentially modifiable, or well modifiable. Non-ventilatory strategies, mainly based on the modification of risk factors, play a key role in reducing PPCs. Non-modifiable risk factors, most importantly age, American Society of Anesthesiologists (ASA) class, and risk of the procedure, should be recognized and patients intensively screened for the potential to optimize other, potentially or well-modifiable, risk factors. Potentially modifiable risk factors, mainly comorbidities and the surgical approach, increase the risk of PPCs. Patient-related factors can be improved while procedure-related factors may be adapted in high-risk patients. Well-modifiable risk factors, mainly certain anesthesia techniques, for example, general anesthesia, intravenous opioids or liberal fluid management, and smoking or alcohol abuse, should be avoided as far as possible in order to prevent PPCs.
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19
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Valkenet K, Trappenburg JCA, Gosselink R, Sosef MN, Willms J, Rosman C, Pieters H, Scheepers JJG, de Heus SC, Reynolds JV, Guinan E, Ruurda JP, Rodrigo EHE, Nafteux P, Fontaine M, Kouwenhoven EA, Kerkemeyer M, van der Peet DL, Hania SW, van Hillegersberg R, Backx FJG. Preoperative inspiratory muscle training to prevent postoperative pulmonary complications in patients undergoing esophageal resection (PREPARE study): study protocol for a randomized controlled trial. Trials 2014; 15:144. [PMID: 24767575 PMCID: PMC4019558 DOI: 10.1186/1745-6215-15-144] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 04/03/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Esophageal resection is associated with a high incidence of postoperative pneumonia. Respiratory complications account for almost half of the readmissions to the critical care unit. Postoperative complications can result in prolonged hospital stay and consequently increase healthcare costs. In cardiac surgery a preoperative inspiratory muscle training program has shown to prevent postoperative pneumonia and reduce length of hospital stay. While in some surgical centers inspiratory muscle training is already used in the preoperative phase in patients undergoing esophageal resection, the added value of this intervention on the reduction of pulmonary complications has not yet been investigated in large surgical populations other than cardiac surgery in a randomized and controlled study design. METHODS/DESIGN The effect of a preoperative inspiratory muscle training program on the incidence of postoperative pneumonia in patients undergoing esophageal resection will be studied in a single blind multicenter randomized controlled trial (the PREPARE study). In total 248 patients (age >18 years) undergoing esophageal resection for esophageal cancer will be included in this study. They are randomized to either usual care or usual care with an additional inspiratory muscle training intervention according to a high-intensity protocol which is performed with a tapered flow resistive inspiratory loading device. Patients have to complete 30 dynamic inspiratory efforts twice daily for 7 days a week until surgery with a minimum of 2 weeks. The starting training load will be aimed to be 60% of maximal inspiratory pressure and will be increased based on the rate of perceived exertion.The main study endpoint is the incidence of postoperative pneumonia. Secondary objectives are to evaluate the effect of preoperative inspiratory muscle training on length of hospital stay, duration of mechanical ventilation, incidence of other postoperative (pulmonary) complications, quality of life, and on postoperative respiratory muscle function and lung function. DISCUSSION The PREPARE study is the first multicenter randomized controlled trial to evaluate the hypothesis that preoperative inspiratory muscle training leads to decreased pulmonary complications in patients undergoing esophageal resection. TRIAL REGISTRATION NCT01893008.
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Affiliation(s)
- Karin Valkenet
- Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, PO Box 85500, Utrecht 3508 GA, The Netherlands
| | - Jaap CA Trappenburg
- Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, PO Box 85500, Utrecht 3508 GA, The Netherlands
| | - Rik Gosselink
- Department of Rehabilitation Sciences, KU Leuven, University Hospital Leuven, Tervuursevest 101, Leuven 3001, Belgium
| | - Meindert N Sosef
- Department of Surgery, Atrium Medical Center, PO Box 4446, Heerlen 6401 CX, The Netherlands
| | - Jerome Willms
- Department of Physical Therapy, Atrium Medical Center, PO Box 4446, Heerlen 6401 CX, The Netherlands
| | - Camiel Rosman
- Department of Surgery, Canisius Wilhelmina Hospital, PO Box 9015, Nijmegen 6500 GS, The Netherlands
| | - Heleen Pieters
- Department of Physical Therapy, Canisius Wilhelmina Hospital, PO Box 9015, Nijmegen 6500 GS, The Netherlands
| | - Joris JG Scheepers
- Department of Surgery, Reinier de Graaf Hospital, PO Box 5011, Delft 2600 GA, The Netherlands
| | - Saskia C de Heus
- Department of Physical Therapy, Reinier de Graaf Hospital, PO Box 5011, Delft 2600 GA, The Netherlands
| | - John V Reynolds
- Department of Surgery, St James’s Hospital, Trinity Centre for Health Sciences, Dublin 8, Ireland
| | - Emer Guinan
- Discipline of Physiotherapy, St James’s Hospital, Trinity Centre for Health Sciences, Dublin 8, Ireland
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, PO Box 85500, Utrecht 3508 GA, The Netherlands
| | - Els HE Rodrigo
- Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, PO Box 85500, Utrecht 3508 GA, The Netherlands
| | - Philippe Nafteux
- Department of Thoracic Surgery, University Hospitals Leuven, Herestraat 49 3000, Leuven, Belgium
| | - Marianne Fontaine
- Department of Physical Therapy, University Hospitals Leuven, Herestraat 49 3000, Leuven, Belgium
| | - Ewout A Kouwenhoven
- Department of Surgery, Hospital Group Twente (ZGT), PO Box 7600, Almelo 7600 SZ, The Netherlands
| | - Margot Kerkemeyer
- Department of Physical Therapy, Hospital Group Twente (ZGT), PO Box 7600, Almelo 7600 SZ, The Netherlands
| | - Donald L van der Peet
- Department of Surgery, VU University Medical Center, PO Box 7057, Amsterdam 1007 MB, The Netherlands
| | - Sylvia W Hania
- Department of Physical Therapy, VU University Medical Center, PO Box 7057, Amsterdam 1007 MB, The Netherlands
| | - Richard van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, PO Box 85500, Utrecht 3508 GA, The Netherlands
| | - Frank JG Backx
- Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, PO Box 85500, Utrecht 3508 GA, The Netherlands
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