[Fewer lung complications following inspiratory muscle training in patients undergoing coronary bypass surgery: a randomized trial].
OBJECTIVE
The aim of this study was to evaluate the prophylactic efficacy of preoperative physiotherapy, including inspiratory muscle training (IMT), on the incidence of postoperative pulmonary complications (PPCs) in high-risk patients scheduled for elective coronary artery bypass grafting (CABG).


METHODS
Randomized controlled clinical trial (www.controlled-trials. com/isrctn17691887).


METHODS
Of 655 patients referred to a university medical centre in The Netherlands for elective CABG, 299 met the criteria for being at high risk of developing PPCs. A total of 279 were enrolled and monitored up to discharge from hospital. Patients were randomly assigned to receive either preoperative IMT (n=140) or usual care (n=139). Both groups received the same postoperative treatment.


RESULTS
Both groups were comparable at baseline. Before CABG, 2 control group patients and 1 IMT group patient died. After CABG surgery, PPCs were present in 25 (18%) of 139 patients in the IMT group and 48 (35%) of 137 patients in the control group (OR: 0.52; 95% 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). Mean duration of postoperative hospitalization was 7 (range 5-41) days in the IMT group versus 8 (range 6-70) days in the usual care group (Mann-Whitney test; Z: -2.42; p = 0.015).


CONCLUSIONS
Preoperative physiotherapy, including IMT, statistically significantly reduced the incidence ofPPCs and the duration ofpostoperative hospitalization in patients at high risk of developing a pulmonary complication on undergoing CABG.
Universitair Medisch Centrum Utrecht, Postbus 85,090, 3508 AB Utrecht. h.hulzebos@umcutrecht.nl
E H J
EH
Hulzebos
P J M
PJ
Helders
N J
NJ
Favié
R A
RA
de Bie
A
A
Brutel de la Rivière
N L U
NL
van Meeteren
D000368:Aged; D001945:Breathing Exercises; D001026:Coronary Artery Bypass; D003371:Cough; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D010996:Pleural Effusion / Q000209:etiology / Q000517:prevention & control; D011014:Pneumonia / Q000209:etiology / Q000517:prevention & control; D011030:Pneumothorax / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011300:Preoperative Care; D012129:Respiratory Function Tests; D012140:Respiratory Tract Diseases / Q000209:etiology* / Q000517:prevention & control*; D018570:Risk Assessment; D016037:Single-Blind Method