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      Multicentre randomized clinical trial of inspiratory muscle training versus usual care before surgery for oesophageal cancer : Inspiratory muscle training before surgery for oesophageal cancer

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          Most cited references31

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          Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial.

          Surgical resection is regarded as the only curative option for resectable oesophageal cancer, but pulmonary complications occurring in more than half of patients after open oesophagectomy are a great concern. We assessed whether minimally invasive oesophagectomy reduces morbidity compared with open oesophagectomy. We did a multicentre, open-label, randomised controlled trial at five study centres in three countries between June 1, 2009, and March 31, 2011. Patients aged 18-75 years with resectable cancer of the oesophagus or gastro-oesophageal junction were randomly assigned via a computer-generated randomisation sequence to receive either open transthoracic or minimally invasive transthoracic oesophagectomy. Randomisation was stratified by centre. Patients, and investigators undertaking interventions, assessing outcomes, and analysing data, were not masked to group assignment. The primary outcome was pulmonary infection within the first 2 weeks after surgery and during the whole stay in hospital. Analysis was by intention to treat. This trial is registered with the Netherlands Trial Register, NTR TC 2452. We randomly assigned 56 patients to the open oesophagectomy group and 59 to the minimally invasive oesophagectomy group. 16 (29%) patients in the open oesophagectomy group had pulmonary infection in the first 2 weeks compared with five (9%) in the minimally invasive group (relative risk [RR] 0·30, 95% CI 0·12-0·76; p=0·005). 19 (34%) patients in the open oesophagectomy group had pulmonary infection in-hospital compared with seven (12%) in the minimally invasive group (0·35, 0·16-0·78; p=0·005). For in-hospital mortality, one patient in the open oesophagectomy group died from anastomotic leakage and two in the minimally invasive group from aspiration and mediastinitis after anastomotic leakage. These findings provide evidence for the short-term benefits of minimally invasive oesophagectomy for patients with resectable oesophageal cancer. Digestive Surgery Foundation of the Unit of Digestive Surgery of the VU University Medical Centre. Copyright © 2012 Elsevier Ltd. All rights reserved.
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            Impact of inspiratory muscle training in patients with COPD: what is the evidence?

            A meta-analysis including 32 randomised controlled trials on the effects of inspiratory muscle training (IMT) in chronic obstructive pulmonary disease (COPD) patients was performed. Overall and subgroup analyses with respect to training modality (strength or endurance training, added to general exercise training) and patient characteristics were performed. Significant improvements were found in maximal inspiratory muscle strength (P(I,max); +13 cmH₂O), endurance time (+261 s), 6- or 12-min walking distance (+32 and +85 m respectively) and quality of life (+3.8 units). Dyspnoea was significantly reduced (Borg score -0.9 point; Transitional Dyspnoea Index +2.8 units). Endurance exercise capacity tended to improve, while no effects on maximal exercise capacity were found. Respiratory muscle endurance training revealed no significant effect on P(I,max), functional exercise capacity and dyspnoea. IMT added to a general exercise programme improved P(I,max) significantly, while functional exercise capacity tended to increase in patients with inspiratory muscle weakness (P(I,max) <60 cmH₂O). IMT improves inspiratory muscle strength and endurance, functional exercise capacity, dyspnoea and quality of life. Inspiratory muscle endurance training was shown to be less effective than respiratory muscle strength training. In patients with inspiratory muscle weakness, the addition of IMT to a general exercise training program improved P(I,max) and tended to improve exercise performance.
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              Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery: a randomized clinical trial.

              Postoperative pulmonary complications (PPCs) after coronary artery bypass graft (CABG) surgery are a major source of morbidity and mortality, and increase length of hospital stay and resource utilization. The prehospitalization period before CABG surgery may be used to improve a patient's pulmonary condition. The efficacy of preoperative inspiratory muscle training (IMT) in reducing the incidence of PPCs in high-risk patients undergoing CABG surgery has not yet been determined. To evaluate the prophylactic efficacy of preoperative IMT on the incidence of PPCs in high-risk patients scheduled for elective CABG surgery. A single-blind, randomized clinical trial conducted at the University Medical Center Utrecht, Utrecht, the Netherlands, with enrollment between July 2002 and August 2005. Of 655 patients referred for elective CABG surgery, 299 (45.6%) met criteria for high risk of developing PPCs, of whom 279 were enrolled and followed up until discharge from hospital. Patients were randomly assigned to receive either preoperative IMT (n = 140) or usual care (n = 139). Both groups received the same postoperative physical therapy. Incidence of PPCs, especially pneumonia, and duration of postoperative hospitalization. Both groups were comparable at baseline. After CABG surgery, PPCs were present in 25 (18.0%) of 139 patients in the IMT group and 48 (35.0%) of 137 patients in the usual care group (odds ratio [OR], 0.52; 95% confidence interval [CI], 0.30-0.92). Pneumonia occurred in 9 (6.5%) of 139 patients in the IMT group and in 22 (16.1%) of 137 patients in the usual care group (OR, 0.40; 95% CI, 0.19-0.84). Median duration of postoperative hospitalization was 7 days (range, 5-41 days) in the IMT group vs 8 days (range, 6-70 days) in the usual care group by Mann-Whitney U statistic (z = -2.42; P = .02). Preoperative IMT reduced the incidence of PPCs and duration of postoperative hospitalization in patients at high risk of developing a pulmonary complication undergoing CABG surgery. isrctn.org Identifier: ISRCTN17691887.
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                Author and article information

                Journal
                British Journal of Surgery
                Br J Surg
                Wiley
                00071323
                April 2018
                April 2018
                March 30 2018
                : 105
                : 5
                : 502-511
                Affiliations
                [1 ]Department of Rehabilitation, Physiotherapy Science and Sports; University Medical Centre Utrecht; Utrecht The Netherlands
                [2 ]Department of Surgery; University Medical Centre Utrecht; Utrecht The Netherlands
                [3 ]Discipline of Physiotherapy, Trinity Centre for Health Sciences; St James's Hospital; Dublin Ireland
                [4 ]Department of Surgery, Trinity Centre for Health Sciences; St James's Hospital; Dublin Ireland
                [5 ]Department of Surgery; University Hospitals Leuven; Leuven Belgium
                [6 ]Department of Physiotherapy; University Hospitals Leuven; Leuven Belgium
                [7 ]Department of Surgery; VU University Medical Centre; Amsterdam The Netherlands
                [8 ]Department of Physiotherapy; VU University Medical Centre; Amsterdam The Netherlands
                [9 ]Department of Surgery; Zuyderland Medical Centre; Heerlen The Netherlands
                [10 ]Department of Physiotherapy; Zuyderland Medical Centre; Heerlen The Netherlands
                [11 ]Department of Surgery; Canisius Wilhelmina Hospital; Nijmegen The Netherlands
                [12 ]Department of Physiotherapy; Canisius Wilhelmina Hospital; Nijmegen The Netherlands
                [13 ]Department of Surgery; Reinier de Graaf Hospital; Delft The Netherlands
                [14 ]Department of Physiotherapy; Reinier de Graaf Hospital; Delft The Netherlands
                [15 ]Department of Surgery; Hospital Group Twente; Almelo The Netherlands
                [16 ]Department of Physiotherapy; Hospital Group Twente; Almelo The Netherlands
                [17 ]Department of Surgery; Helsinki University Central Hospital; Helsinki Finland
                [18 ]Department of Physiotherapy; Helsinki University Central Hospital; Helsinki Finland
                [19 ]Rehabilitation Sciences; University Hospitals Leuven; Leuven Belgium
                Article
                10.1002/bjs.10803
                b44df8e5-9995-4622-9158-6cd1ddae2c18
                © 2018

                http://doi.wiley.com/10.1002/tdm_license_1.1

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