Chest
Volume 105, Issue 6, June 1994, Pages 1782-1788
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Physio-Therapy: Clinical Investigations
Preoperative Respiratory Muscle Training: Assessment in Thoracic Surgery Patients With Special Reference to Postoperative Pulmonary Complications

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Study objective

To assess the usefulness of preoperative respiratory muscle training to increase muscle strength and its effects on postoperative pulmonary complications.

Design

We measured maximum inspiratory (MIP) and maximum expiratory (MEP) mouth pressure before and after training in 50 patients undergoing thoracic surgery. For control purposes, MIP and MEP were measured in 50 age- and sex-matched healthy subjects at two different times without training.

Results

Preoperative respiratory muscle training increased both MIP and MEP significantly (p<0.01), while the control subjects showed no increase in these parameters. Eight patients who had postoperative pulmonary complications had significantly lower values (p<0.01) and did not show significant increases in either MIP or MEP even after the training, unlike the other patients, who were without postoperative pulmonary complications. On the other hand, there were also another six patients who had equally low MIP and MEPs before training, but who raised their values with training and avoided the postoperative pulmonary complications.

Conclusion

Preoperative respiratory muscle training may prevent postoperative pulmonary complications by increasing both inspiratory and expiratory muscle strength in patients undergoing thoracic surgery. Patients with respiratory muscle weakness have a higher risk of postoperative pulmonary complications.

Section snippets

Patients

We studied 50 consecutive patients who underwent thoracic surgery between June 1992 and June 1993 (Table 1). Cases with pneumothorax were excluded because of the impossibility of measuring the values of MIP and MEP due to intrathoracic air leakage. There were 37 men and 13 women aged 24 to 73 years old (55±13 [SD]). Their diseases were lung tumor in 31, mediastinal tumor in 6, chronic empyema in 6, chest wall tumor in 2, giant bulla in 2, and esophageal tumor in 3 patients. Mean body surface

RESULTS

In the training group (patients undergoing thoracic surgery), the percent VC before and after respiratory muscle training was 93.7±20.9 and 95.1 ± 20.5 percent, respectively, and the corresponding FEV1 percent was 78.0±8.6 and 78.5±8.7 percent. In the control group, percent VC at the first and the second measurements was 101±15.9 and 100±16.1 percent, respectively, and the corresponding FEV1 percent was 78.8±8.5 and 79.2±8.5 percent. There were no significant differences in either group between

DISCUSSION

The present study demonstrates that preoperative respiratory muscle training increases the strength of both inspiratory and expiratory muscles. The muscles used for inspiration are the diaphragm, external intercostals, sternocleidomastoid, scalenes, serratus anterior, pectoralis major, pectoralis minor, trapezius, and erector spinae muscles. Of these, the first two muscles are used in normal inspiration.8 In contrast, normal expiration is a passive process, occurring when the intercostal

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