Preoperative IMT to prevent post-op pulmonary complications

Study Protocol:

Preoperative Inspiratory Muscle Training to prevent postoperative pulmonary complications in patients undergoing esophageal resection (PREPARE study): study protocl for a randomized controlled trial

This is an Open Access article, published April 2014.

Background:

“Esophageal resection is associated with a high incidence of postoperative pneumonia. Respiratory complications account for almost half of the readmissions to the critical care unit. Postoperative complications can result in prolonged hospital stay and consequently increase healthcare costs. In cardiac surgery a preoperative inspiratory muscle training program has shown to prevent postoperative pneumonia and reduce length of hospital stay. While in some surgical centers inspiratory muscle training is already used in the preoperative phase in patients undergoing esophageal resection, the added value of this intervention on the reduction of pulmonary complications has not yet been investigated in large surgical populations other than cardiac surgery in a randomized and controlled study design.”

Methods/Design:

“The effect of a preoperative inspiratory muscle training program on the incidence of postoperative pneumonia in patients undergoing esophageal resection will be studied in a single blind multicenter randomized controlled trial (the PREPARE study).

In total 248 patients (age >18 years) undergoing esophageal resection for esophageal cancer will be included in this study. They are randomized to either usual care or usual care with an additional inspiratory muscle training intervention according to a high-intensity protocol which is performed with a tapered flow resistive inspiratory loading device. Patients have to complete 30 dynamic inspiratory efforts twice daily for 7 days a week until surgery with a minimum of 2 weeks. The starting training load will be aimed to be 60% of maximal inspiratory pressure and will be increased based on the rate of perceived exertion.The main study endpoint is the incidence of postoperative pneumonia. Secondary objectives are to evaluate the effect of preoperative inspiratory muscle training on length of hospital stay, duration of mechanical ventilation, incidence of other postoperative (pulmonary) complications, quality of life, and on postoperative respiratory muscle function and lung function.”

Intervention:

“The intervention used in this study entails the use of a tapered flow resistive inspiratory loading device: the POWERbreathe K3-series, an electronic IMT and monitoring system. It allows storing the data of the unsupervised training sessions to control compliance with the treatment.”

Discussion:

“The PREPARE study is the first multicenter randomized controlled trial to evaluate the hypothesis that preoperative inspiratory muscle training leads to decreased pulmonary complications in patients undergoing esophageal resection…”

“…Furthermore, the memory of the digital inspiratory muscle trainer (POWERbreathe K3-series) enables PTs to compare the last 36 training sessions with the recorded data in the patient diary which enables a supplementary check on patient compliance and adequate adjustment of the training load.”

Trial registration: NCT01893008.

View the Study Protocol.

View list of published research that used POWERbreathe as the IMT intervention of choice in POWERbreathe in Research.

Find more published research on our Inspiratory Muscle Training Research blog.

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