José Francisco Cursino de Moura , Crystian Bitencourt Oliveira , Ana Paula Coelho Figueira Freire , Mark Russell Elkins , Francis Lopes Pacagnelli
{"title":"术前呼吸肌训练可降低心脏手术后肺部并发症的风险和住院时间:一项系统综述。","authors":"José Francisco Cursino de Moura , Crystian Bitencourt Oliveira , Ana Paula Coelho Figueira Freire , Mark Russell Elkins , Francis Lopes Pacagnelli","doi":"10.1016/j.jphys.2023.10.012","DOIUrl":null,"url":null,"abstract":"<div><h3>Questions</h3><p>What is the effect of preoperative respiratory muscle training (RMT) on the incidence of postoperative pulmonary complications (PPCs) after open cardiac surgery? What is the effect of RMT on the duration of mechanical ventilation, postoperative length of stay and respiratory muscle strength?</p></div><div><h3>Design</h3><p>Systematic review of randomised trials with meta-analysis.</p></div><div><h3>Participants</h3><p>Adults undergoing elective open cardiac surgery.</p></div><div><h3>Intervention</h3><p>The experimental groups received preoperative RMT and the comparison groups received no intervention.</p></div><div><h3>Outcome measures</h3><p>The primary outcomes were PPCs, length of hospital stay, respiratory muscle strength, oxygenation and duration of mechanical ventilation. The methodological quality of studies was assessed using the PEDro scale and the overall certainty of the evidence was assessed using the GRADE approach.</p></div><div><h3>Results</h3><p>Eight trials involving 696 participants were included. Compared with the control group, the respiratory training group had fewer PPCs (RR 0.51, 95% CI 0.38 to 0.70), less pneumonia (RR 0.44, 95% CI 0.25 to 0.78), shorter hospital stay (MD −1.7 days, 95% CI −2.4 to −1.1) and higher maximal inspiratory pressure values at the end of the training protocol (MD 12 cmH<sub>2</sub>O, 95% CI 8 to 16). The mechanical ventilation time was similar in both groups. The quality of evidence was high for pneumonia, length of hospital stay and maximal inspiratory pressure.</p></div><div><h3>Conclusion</h3><p>Preoperative RMT reduced the risk of PPCs and pneumonia after cardiac surgery. The training also improved the maximal inspiratory pressure and reduced hospital stay. The effects on PPCs were large enough to warrant use of RMT in this population.</p></div><div><h3>Registration</h3><p>CRD42021227779</p></div>","PeriodicalId":49153,"journal":{"name":"Journal of Physiotherapy","volume":"70 1","pages":"Pages 16-24"},"PeriodicalIF":9.7000,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1836955323001170/pdfft?md5=bec5de692bccdf3eaee5f11b9fb8d31e&pid=1-s2.0-S1836955323001170-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Preoperative respiratory muscle training reduces the risk of pulmonary complications and the length of hospital stay after cardiac surgery: a systematic review\",\"authors\":\"José Francisco Cursino de Moura , Crystian Bitencourt Oliveira , Ana Paula Coelho Figueira Freire , Mark Russell Elkins , Francis Lopes Pacagnelli\",\"doi\":\"10.1016/j.jphys.2023.10.012\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Questions</h3><p>What is the effect of preoperative respiratory muscle training (RMT) on the incidence of postoperative pulmonary complications (PPCs) after open cardiac surgery? 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引用次数: 0
摘要
问题:术前呼吸肌训练(RMT)对心脏直视手术后肺部并发症(PPCs)的发生率有何影响?RMT对机械通气时间、术后停留时间和呼吸肌力量有何影响?设计:采用荟萃分析对随机试验进行系统评价。参与者:接受择期心脏直视手术的成年人。干预:实验组术前行RMT治疗，对照组不进行干预。结局指标:主要结局为PPCs、住院时间、呼吸肌力量、氧合和机械通气持续时间。使用PEDro量表评估研究的方法学质量，使用GRADE方法评估证据的总体确定性。结果:纳入8项试验，696名受试者。与对照组相比，呼吸训练组PPCs发生率较低(RR 0.51, 95% CI 0.38 ~ 0.70)，肺炎发生率较低(RR 0.44, 95% CI 0.25 ~ 0.78)，住院时间较短(MD -1.7天，95% CI -2.4 ~ -1.1)，训练方案结束时最大吸气压力值较高(MD 12 cmH2O, 95% CI 8 ~ 16)。两组患者机械通气时间相似。肺炎、住院时间和最大吸气压力的证据质量较高。结论:术前RMT可降低心脏手术后PPCs和肺炎的发生风险。该训练还提高了最大吸气压力，缩短了住院时间。对PPCs的影响足够大，足以保证在该人群中使用RMT。注册:CRD42021227779。
Preoperative respiratory muscle training reduces the risk of pulmonary complications and the length of hospital stay after cardiac surgery: a systematic review
Questions
What is the effect of preoperative respiratory muscle training (RMT) on the incidence of postoperative pulmonary complications (PPCs) after open cardiac surgery? What is the effect of RMT on the duration of mechanical ventilation, postoperative length of stay and respiratory muscle strength?
Design
Systematic review of randomised trials with meta-analysis.
Participants
Adults undergoing elective open cardiac surgery.
Intervention
The experimental groups received preoperative RMT and the comparison groups received no intervention.
Outcome measures
The primary outcomes were PPCs, length of hospital stay, respiratory muscle strength, oxygenation and duration of mechanical ventilation. The methodological quality of studies was assessed using the PEDro scale and the overall certainty of the evidence was assessed using the GRADE approach.
Results
Eight trials involving 696 participants were included. Compared with the control group, the respiratory training group had fewer PPCs (RR 0.51, 95% CI 0.38 to 0.70), less pneumonia (RR 0.44, 95% CI 0.25 to 0.78), shorter hospital stay (MD −1.7 days, 95% CI −2.4 to −1.1) and higher maximal inspiratory pressure values at the end of the training protocol (MD 12 cmH2O, 95% CI 8 to 16). The mechanical ventilation time was similar in both groups. The quality of evidence was high for pneumonia, length of hospital stay and maximal inspiratory pressure.
Conclusion
Preoperative RMT reduced the risk of PPCs and pneumonia after cardiac surgery. The training also improved the maximal inspiratory pressure and reduced hospital stay. The effects on PPCs were large enough to warrant use of RMT in this population.
期刊介绍：
The Journal of Physiotherapy is the official journal of the Australian Physiotherapy Association. It aims to publish high-quality research with a significant impact on global physiotherapy practice. The journal's vision is to lead the field in supporting clinicians to access, understand, and implement research evidence that will enhance person-centred care. In January 2008, the Journal of Physiotherapy became the first physiotherapy journal to adhere to the ICMJE requirement of registering randomized trials with a recognized Trial Registry. The journal prioritizes systematic reviews, clinical trials, economic analyses, experimental studies, qualitative studies, epidemiological studies, and observational studies. In January 2014, it also became the first core physiotherapy/physical therapy journal to provide free access to editorials and peer-reviewed original research. The Australian Physiotherapy Association extended their support for excellence in physiotherapy practice by sponsoring open access publication of all Journal of Physiotherapy content in 2016. As a result, all past, present, and future journal articles are freely accessible, and there are no author fees for publication.
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