Preoperative Inspiratory Muscle Training in Patients Undergoing Coronary Artery Bypass Graft Surgery: A Practical Guidance for Rehabilitation Physicians
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Published:
Dec 28, 2024
Keywords:
Coronary Artery Bypass Graft, Coronary Artery Disease, Length of Stay, Muscle Strength, Respiratory Muscles
Main Article Content
Abstract
Introduction: Coronary artery bypass graft (CABG) surgery increases the life expectancy of coronary artery disease patients, but the surgery itself causes postoperative pulmonary complications (PPC). PPC was associated with a decrease in respiratory muscle and lung function. Inspiratory muscle trainer (IMT) has been used in cardiac rehabilitation for post-CABG surgery patients. This review aimed at guiding clinical practitioners in preoperative IMT use.
Methods: Articles written in English were searched using PubMed, EBSCOhost, and Google Scholar databases without limitation of year of publication used relevant keywords. The inclusion criteria were participants undergoing CABG surgery in the pre-operative period and were given threshold IMT.
Result and Discussion: Preoperative IMT did not increase lung function, but it prevented a decrease in lung function postoperatively. The incidence of PPC was lower and the length of stay was shorter in patients who were given preoperative IMT compared to the control. Preoperative IMT also increased the strength and endurance of inspiratory muscles associated with decreased PPC.
Conclusion: Preoperative IMT given to patients undergoing CABG surgery has been proven to prevent PPC and increase respiratory muscle function. This review provides practical guidance for preoperative IMT administration to improve outcomes of patients undergoing CABG surgery.
Methods: Articles written in English were searched using PubMed, EBSCOhost, and Google Scholar databases without limitation of year of publication used relevant keywords. The inclusion criteria were participants undergoing CABG surgery in the pre-operative period and were given threshold IMT.
Result and Discussion: Preoperative IMT did not increase lung function, but it prevented a decrease in lung function postoperatively. The incidence of PPC was lower and the length of stay was shorter in patients who were given preoperative IMT compared to the control. Preoperative IMT also increased the strength and endurance of inspiratory muscles associated with decreased PPC.
Conclusion: Preoperative IMT given to patients undergoing CABG surgery has been proven to prevent PPC and increase respiratory muscle function. This review provides practical guidance for preoperative IMT administration to improve outcomes of patients undergoing CABG surgery.
Article Details
How to Cite
Nazir, A. (2024). Preoperative Inspiratory Muscle Training in Patients Undergoing Coronary Artery Bypass Graft Surgery: A Practical Guidance for Rehabilitation Physicians. Indonesian Journal of Physical Medicine and Rehabilitation, 13(2), 135 - 149. https://doi.org/10.36803/indojpmr.v13i2.407
Section
Literature Review
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References
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3. Hämäläinen L, Kohonen M, Laurikka J. Health-related quality of life is improved after coronary artery bypass graft surgery: a 1-year follow-up study. Scand Cardiovasc J. 2023;57(1):2284083.
4. Hussain SMA, Harky A. Complications of coronary artery bypass grafting. Int J Med Rev. 2019;6(1):1-5.
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7. Vargas F, Terra-Filho M, Hueb W, Teixeira L, Cukier A, Light R. Pulmonary function after coronary artery bypass surgery. Respir Med. 1997;91(10):629-33.
8. Shenkman Z, Shir Y, Weiss Y, Bleiberg B, Gross D. The effects of cardiac surgery on early and late pulmonary functions. Acta Anaesthesiol Scand. 1997;41(9):1193-9.
9. Van Belle A, Wesseling G, Penn O, Wouters E. Postoperative pulmonary function abnormalities after coronary artery bypass surgery. Respir Med. 1992;86(3):195-9.
10. Naseer BA, Al-Shenqiti AM, Ali ARH, Aljeraisi T. Effect of cardiac surgery on respiratory muscle strength. J Taibah Univ Med Sci. 2019;14(4):337-42.
11. Weiner P, Zeidan F, Zamir D, Pelled B, Waizman J, Beckerman M, et al. Prophylactic inspiratory muscle training in patients undergoing coronary artery bypass graft. World J Surg. 1998;22(5):427-31.
12. Zhang S, Li B, Meng X, Zuo H, Hu D. The effects of inspiratory muscle training (IMT) on patients undergoing coronary artery bypass graft (CABG) surgery: a systematic review and meta-analysis. Rev Cardiovasc Med. 2023;24(1):16.
13. A primer on inspiratory muscle trainers [Internet]. 2006 [cited February 20, 2024]. Available from: https://www.researchgate.net/profile/W-Darlene-Reid-2/publication/228373385_A_primer_on_inspiratory_muscle_trainers/links/0c960532858c72419b000000/A-primer-on-inspiratory-muscle-trainers.pdf.
14. Shei R-J, Paris HL, Sogard AS, Mickleborough TD. Time to move beyond a “one-size fits all” approach to inspiratory muscle training. Front Physiol. 2022;12:766346.
15. Hill K, Cecins NM, Eastwood PR, Jenkins SC. Inspiratory muscle training for patients with chronic obstructive pulmonary disease: a practical guide for clinicians. Arch Phys Med Rehabil. 2010;91(9):1466-70.
16. Vázquez-Gandullo E, Hidalgo-Molina A, Montoro-Ballesteros F, Morales-González M, Muñoz-Ramírez I, Arnedillo-Muñoz A. Inspiratory muscle training in patients with chronic obstructive pulmonary disease (COPD) as part of a respiratory rehabilitation program implementation of mechanical devices: a systematic review. Int J Environ Res Public Health. 2022;19(9):5564.
17. Madariaga VB, Iturri JBG, Manterola AG, Buey JC, Sebastián NT, Peña VS. Comparison of 2 methods for inspiratory muscle training in patients with chronic obstructive pulmonary disease. Arch Bronconeumol. 2007;43(8):431-8.
18. Respiratory pressure meter – RP Check [Internet]. MD Diagnostics Ltd – The Breath Test Experts. 2024 [cited February 23, 2024]. Available from: https://www.mdd.org.uk/products/respiratory-pressure-meter-rp-check/.
19. Nield MA. Inspiratory muscle training protocol using a pressure threshold device: effect on dyspnea in chronic obstructive pulmonary disease. Arch Phys Med Rehabil. 1999;80(1):100-2.
20. Hermes BM, Cardoso DM, Gomes TJN, Santos TDd, Vicente MS, Pereira SN, et al. Short-term inspiratory muscle training potentiates the benefits of aerobic and resistance training in patients undergoing CABG in phase II cardiac rehabilitation program. Rev Bras Cir Cardiovasc. 2015;30(4):474-81.
21. Dos Santos TD, Pereira SN, Portela LOC, Cardoso DM, Dal Lago P, dos Santos Guarda N, et al. Moderate-to-high intensity inspiratory muscle training improves the effects of combined training on exercise capacity in patients after coronary artery bypass graft surgery: A randomized clinical trial. Int J Cardiol. 2019;279:40-6.
22. Hulzebos EH, Helders PJ, Favié NJ, De Bie RA, de la Riviere AB, Van Meeteren NL. Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery: a randomized clinical trial. JAMA. 2006;296(15):1851-7.
23. Mishra SK, Veena M, Nagaraja P, Singh NG. Preoperative Inspiratory Muscle Training to Prevent Post-Operative Pulmonary Complication Its Effectiveness in Patients Undergoing On Pump Coronary Artery Bypass Grafting (CABG) Surgery. Sch J App Med Sci. 2016;4(12D):4531-5.
24. Valkenet K, Trappenburg J, Hulzebos E, Van Meeteren N, Backx F. Effects of a pre-operative home-based inspiratory muscle training programme on perceived health-related quality of life in patients undergoing coronary artery bypass graft surgery. Physiotherapy. 2017;103(3):276-82.
25. Savci S, Degirmenci B, Saglam M, Arikan H, Inal-Ince D, Turan HN, et al. Short-term effects of inspiratory muscle training in coronary artery bypass graft surgery: a randomized controlled trial. Scand Cardiovasc J. 2011;45(5):286-93.
26. Elmarakby A. Effect of threshold inspiratory muscle training on maximal inspiratory pressure and pulmonary gas exchange in patients undergoing coronary artery bypass graft surgery. Crit Rev Phys Rehabil Med. 2016;28(4).
27. Turky K, Afify AMA. Effect of preoperative inspiratory muscle training on alveolar-arterial oxygen gradients after coronary artery bypass surgery. J Cardiopulm Rehabil Prev. 2017;37(4):290-4.
28. Valkenet K, De Heer F, Backx FJ, Trappenburg JC, Hulzebos EH, Kwant S, et al. Effect of inspiratory muscle training before cardiac surgery in routine care. Phys Ther. 2013;93(5):611-9.
2. Charlson ME, Isom OW. Care after coronary-artery bypass surgery. N Engl J Med. 2003;348(15):1456-63.
3. Hämäläinen L, Kohonen M, Laurikka J. Health-related quality of life is improved after coronary artery bypass graft surgery: a 1-year follow-up study. Scand Cardiovasc J. 2023;57(1):2284083.
4. Hussain SMA, Harky A. Complications of coronary artery bypass grafting. Int J Med Rev. 2019;6(1):1-5.
5. Westerdahl E, Lindmark B, Bryngelsson I, Tenling A. Pulmonary function 4 months after coronary artery bypass graft surgery. Respir Med. 2003;97(4):317-22.
6. Rouhi-Boroujeni H, Rouhi-Boroujeni H, Rouhi-Boroujeni P, Sedehi M. Long-term pulmonary functional status following coronary artery bypass grafting surgery. ARYA Atheroscler. 2015;11(2):163-6.
7. Vargas F, Terra-Filho M, Hueb W, Teixeira L, Cukier A, Light R. Pulmonary function after coronary artery bypass surgery. Respir Med. 1997;91(10):629-33.
8. Shenkman Z, Shir Y, Weiss Y, Bleiberg B, Gross D. The effects of cardiac surgery on early and late pulmonary functions. Acta Anaesthesiol Scand. 1997;41(9):1193-9.
9. Van Belle A, Wesseling G, Penn O, Wouters E. Postoperative pulmonary function abnormalities after coronary artery bypass surgery. Respir Med. 1992;86(3):195-9.
10. Naseer BA, Al-Shenqiti AM, Ali ARH, Aljeraisi T. Effect of cardiac surgery on respiratory muscle strength. J Taibah Univ Med Sci. 2019;14(4):337-42.
11. Weiner P, Zeidan F, Zamir D, Pelled B, Waizman J, Beckerman M, et al. Prophylactic inspiratory muscle training in patients undergoing coronary artery bypass graft. World J Surg. 1998;22(5):427-31.
12. Zhang S, Li B, Meng X, Zuo H, Hu D. The effects of inspiratory muscle training (IMT) on patients undergoing coronary artery bypass graft (CABG) surgery: a systematic review and meta-analysis. Rev Cardiovasc Med. 2023;24(1):16.
13. A primer on inspiratory muscle trainers [Internet]. 2006 [cited February 20, 2024]. Available from: https://www.researchgate.net/profile/W-Darlene-Reid-2/publication/228373385_A_primer_on_inspiratory_muscle_trainers/links/0c960532858c72419b000000/A-primer-on-inspiratory-muscle-trainers.pdf.
14. Shei R-J, Paris HL, Sogard AS, Mickleborough TD. Time to move beyond a “one-size fits all” approach to inspiratory muscle training. Front Physiol. 2022;12:766346.
15. Hill K, Cecins NM, Eastwood PR, Jenkins SC. Inspiratory muscle training for patients with chronic obstructive pulmonary disease: a practical guide for clinicians. Arch Phys Med Rehabil. 2010;91(9):1466-70.
16. Vázquez-Gandullo E, Hidalgo-Molina A, Montoro-Ballesteros F, Morales-González M, Muñoz-Ramírez I, Arnedillo-Muñoz A. Inspiratory muscle training in patients with chronic obstructive pulmonary disease (COPD) as part of a respiratory rehabilitation program implementation of mechanical devices: a systematic review. Int J Environ Res Public Health. 2022;19(9):5564.
17. Madariaga VB, Iturri JBG, Manterola AG, Buey JC, Sebastián NT, Peña VS. Comparison of 2 methods for inspiratory muscle training in patients with chronic obstructive pulmonary disease. Arch Bronconeumol. 2007;43(8):431-8.
18. Respiratory pressure meter – RP Check [Internet]. MD Diagnostics Ltd – The Breath Test Experts. 2024 [cited February 23, 2024]. Available from: https://www.mdd.org.uk/products/respiratory-pressure-meter-rp-check/.
19. Nield MA. Inspiratory muscle training protocol using a pressure threshold device: effect on dyspnea in chronic obstructive pulmonary disease. Arch Phys Med Rehabil. 1999;80(1):100-2.
20. Hermes BM, Cardoso DM, Gomes TJN, Santos TDd, Vicente MS, Pereira SN, et al. Short-term inspiratory muscle training potentiates the benefits of aerobic and resistance training in patients undergoing CABG in phase II cardiac rehabilitation program. Rev Bras Cir Cardiovasc. 2015;30(4):474-81.
21. Dos Santos TD, Pereira SN, Portela LOC, Cardoso DM, Dal Lago P, dos Santos Guarda N, et al. Moderate-to-high intensity inspiratory muscle training improves the effects of combined training on exercise capacity in patients after coronary artery bypass graft surgery: A randomized clinical trial. Int J Cardiol. 2019;279:40-6.
22. Hulzebos EH, Helders PJ, Favié NJ, De Bie RA, de la Riviere AB, Van Meeteren NL. Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery: a randomized clinical trial. JAMA. 2006;296(15):1851-7.
23. Mishra SK, Veena M, Nagaraja P, Singh NG. Preoperative Inspiratory Muscle Training to Prevent Post-Operative Pulmonary Complication Its Effectiveness in Patients Undergoing On Pump Coronary Artery Bypass Grafting (CABG) Surgery. Sch J App Med Sci. 2016;4(12D):4531-5.
24. Valkenet K, Trappenburg J, Hulzebos E, Van Meeteren N, Backx F. Effects of a pre-operative home-based inspiratory muscle training programme on perceived health-related quality of life in patients undergoing coronary artery bypass graft surgery. Physiotherapy. 2017;103(3):276-82.
25. Savci S, Degirmenci B, Saglam M, Arikan H, Inal-Ince D, Turan HN, et al. Short-term effects of inspiratory muscle training in coronary artery bypass graft surgery: a randomized controlled trial. Scand Cardiovasc J. 2011;45(5):286-93.
26. Elmarakby A. Effect of threshold inspiratory muscle training on maximal inspiratory pressure and pulmonary gas exchange in patients undergoing coronary artery bypass graft surgery. Crit Rev Phys Rehabil Med. 2016;28(4).
27. Turky K, Afify AMA. Effect of preoperative inspiratory muscle training on alveolar-arterial oxygen gradients after coronary artery bypass surgery. J Cardiopulm Rehabil Prev. 2017;37(4):290-4.
28. Valkenet K, De Heer F, Backx FJ, Trappenburg JC, Hulzebos EH, Kwant S, et al. Effect of inspiratory muscle training before cardiac surgery in routine care. Phys Ther. 2013;93(5):611-9.