Multicentre randomized clinical trial of inspiratory muscle training versus usual care before surgery for oesophageal cancer

作者：Valkenet K^*; Trappenburg J C A; Ruurda J P; Guinan E M; Reynolds J V; Nafteux P; Fontaine M; Rodrigo H E; van der Peet D L; Hania S W; Sosef M N; Willms J; Rosman C; Pieters H; Scheepers J J G; Faber T; Kouwenhoven E A; Tinselboer M; Rasanen J; Ryynanen H; Gosselink R; van Hilleger**erg R; Backx F J G

来源：British Journal of Surgery, 2018, 105(5): 502-511.

DOI：10.1002/bjs.10803

BackgroundUp 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.
MethodsPatients 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.
ResultsPostoperative pneumonia was diagnosed in 47 (392 per cent) of 120 patients in the IMT group and in 43 (355 per cent) of 121 patients in the control group (relative risk 110, 95 per cent c.i. 079 to 153; P=0561). There was no statistically significant difference in postoperative outcomes between the groups. Mean(s.d.) maximal inspiratory muscle strength increased from 762(264) to 890(294) cmH(2)O (P<0001) in the intervention group and from 740(302) to 800(301) cmH(2)O in the control group (P<0001). Preoperative inspiratory muscle endurance increased from 4min 14s to 7min 17s in the intervention group (P<0001) and from 4min 20s to 5min 5s in the control group (P=0007). The increases were highest in the intervention group (P<0050).
ConclusionDespite 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).
Increased muscle function, no better outcome

• 出版日期2018-4