Prevention of pulmonary complications after upper abdominal surgery by preoperative intensive inspiratory muscle training: a randomized controlled pilot study

Objective: To investigate the feasibility and effects of preoperative inspiratory muscle training on the incidence of atelectasis in patients at high risk of postoperative pulmonary complications scheduled for elective abdominal aortic aneurysm surgery. Design: Single-blind randomized controlled pilot study. Setting: Gelderse Vallei Hospital Ede, the Netherlands. Subjects: Twenty high-risk patients undergoing elective abdominal aortic aneurysm surgery were randomly assigned to receive preoperative inspiratory muscle training or usual care. Main measures: Effectiveness outcome variables were atelectasis, inspiratory muscle strength and vital capacity, and feasibility outcome variables were adverse effects and patient satisfaction with inspiratory muscle training. Results: Despite randomization, patients in the intervention group were significantly older than the patients in the control group (70 +/- 6 years versus 59 +/- 6 years, respectively; P=0.001). Eight patients in the control group and three in the intervention group developed atelectasis (P=0.07). The median duration of atelectasis was 0 days in the intervention group and 1.5 days in the control group (P=0.07). No adverse effects of preoperative inspiratory muscle training were observed and patients considered that inspiratory muscle training was a good preparation for surgery. Mean postoperative inspiratory pressure was 10% higher in the intervention group. Conclusion: Preoperative inspiratory muscle training is well tolerated and appreciated and seems to reduce the incidence of atelectasis in patients scheduled for elective abdominal aortic aneurysm surgery.