Perioperative respiratory muscle exercise in patients undergoing cardiac surgery: An evidence-based review

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung Pub Date : 2024-11-27 DOI:10.1016/j.hrtlng.2024.10.017

Qiaoying Wang , Yanchun Peng , Shurong Xu , Huan Guo , Yaqin Chen , Lingyu Lin , Liangwan Chen , Yanjuan Lin

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引用次数: 0

Abstract

Background

Enhanced respiratory muscle management is imperative in cardiac surgery patients due to their universal risk of decreased perioperative respiratory muscle strength.

Objectives

Most existing articles primarily examine respiratory muscle exercise during either the preoperative, postoperative, or at-home phases. Consequently, there is a crucial need to consolidate the evidence for respiratory muscle exercise throughout the perioperative period of cardiac surgery.

Methods

A literature search was performed, encompassing guideline networks and databases up until July 2023. The literature was classified into seven thematic categories: preoperative assessment, patient education, trainers, training plans, quality control, safety monitoring, and outcome assessment. The quality of the included literature was assessed using the GRAGE evidence grading system to ascertain the level of recommendation associated with each piece of evidence.

Results

Nineteen papers were reviewed, encompassing 24 suggestions. These consisted of two suggestions on preoperative assessment, four on patient education, two on trainers, six on training programs, seven on quality control, two on safety monitoring, and one on outcome assessment. All 24 suggestions were categorized as strong recommendations, with 14 classified as high-quality evidence and ten as moderate-quality evidence.

Conclusions

Our study presents a succinct synthesis of the most robust evidence available on perioperative respiratory muscle exercise in cardiac surgery patients. We identified ten high-quality suggestions while an additional 14 moderate-quality suggestions. In the context of perioperative exercise, we recommend that moderate-intensity inspiratory muscle exercises be provided during the preoperative and postoperative phases upon transfer to the ward. We advocate for the implementation of low-intensity inspiratory muscle exercises during the postoperative phase while patients are in the intensive care unit.

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心脏手术患者围手术期的呼吸肌锻炼：循证综述

背景由于心脏手术患者普遍存在围手术期呼吸肌力量下降的风险，因此加强呼吸肌管理对于心脏手术患者来说势在必行。目的现有的大多数文章主要研究了术前、术后或居家阶段的呼吸肌锻炼。因此，亟需整合心脏手术围术期呼吸肌锻炼的相关证据。方法对截至 2023 年 7 月的文献进行检索，检索范围包括指南网络和数据库。文献分为七个主题类别：术前评估、患者教育、培训师、培训计划、质量控制、安全监测和结果评估。采用 GRAGE 证据分级系统对收录文献的质量进行评估，以确定与每项证据相关的建议级别。这些建议包括两项关于术前评估的建议、四项关于患者教育的建议、两项关于培训师的建议、六项关于培训计划的建议、七项关于质量控制的建议、两项关于安全监控的建议以及一项关于结果评估的建议。所有 24 项建议均被归类为强烈建议，其中 14 项被归类为高质量证据，10 项被归类为中等质量证据。结论我们的研究简明扼要地总结了有关心脏手术患者围手术期呼吸肌锻炼的现有最有力证据。我们确定了 10 项高质量建议和 14 项中等质量建议。在围手术期锻炼方面，我们建议在术前和术后转入病房时进行中等强度的吸气肌肉锻炼。我们主张在术后患者入住重症监护室期间进行低强度的吸气肌肉锻炼。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Heart & Lung 医学-呼吸系统

CiteScore

4.60

自引率

3.60%

发文量

184

审稿时长

35 days

期刊介绍： Heart & Lung: The Journal of Cardiopulmonary and Acute Care, the official publication of The American Association of Heart Failure Nurses, presents original, peer-reviewed articles on techniques, advances, investigations, and observations related to the care of patients with acute and critical illness and patients with chronic cardiac or pulmonary disorders. The Journal''s acute care articles focus on the care of hospitalized patients, including those in the critical and acute care settings. Because most patients who are hospitalized in acute and critical care settings have chronic conditions, we are also interested in the chronically critically ill, the care of patients with chronic cardiopulmonary disorders, their rehabilitation, and disease prevention. The Journal''s heart failure articles focus on all aspects of the care of patients with this condition. Manuscripts that are relevant to populations across the human lifespan are welcome.