scholarly journals Effect of Additional Threshold Inspiratory Muscle Training Preoperative on Pulmonary Complication Post Heart Valve Replacement Surgery

2020 ◽  
Vol 9 (1) ◽  
pp. 19-28
Author(s):  
Erna Setiawati ◽  
Ronni Untung Handayanto ◽  
Sri Wahyudati
Keyword(s):  
Valve Replacement ◽  
Pulmonary Complication ◽  
Intervention Group ◽  
Inspiratory Muscle ◽  
Inspiratory Muscle Training ◽  
Control Group ◽  
Postoperative Pulmonary Complication ◽  
Muscle Training ◽  
Replacement Surgery ◽  
Valve Replacement Surgery

ABSTRACT Introduction: Cardiac surgery has been improved patient’s outcome with cardiac valve anomaly. There was 111 cardiac valve replacement surgery performed in Kariadi General Hospital Semarang in 2018.Postoperative pulmonary complication (PPC) is the most common complication in this procedure compared to cardiac complication which are thought caused by the disruption of normal respiratory function as a result from surgical and anesthetic procedure. Additional preoperative threshold inspiratory muscle training (Threshold IMT) has been considered as an ef fective intervention to reduce PPC. Methods: This is a quasi experimental study with main reason to know the role of Threshold IMT on PPC incidences. Subjects in the intervention group were given routine conventional rehabilitationexercises according to Clinical Practice Guide (PPK) with additional of Threshold IMT, which applied based on research protocols, while control group did convention al rehabilitation exercises only. Results: 18 subjects were divided into intervention group (n=9), and control group (n=9), PPC incidences (Intervention group n=2, control group n=7) were analyzed statistically using Chi-squared test andshowed significant differences (Fisher exact test p=0.02 with α=0.05). Conclusion: Additional of Threshold IMT preoperative may reduce the incidence of PPC on heart valve replacement surgery.Keywords: Postoperative pulmonary complication (PPC), Threshold inspiratory muscle training (Threshold IMT)

scholarly journals Pengaruh Threshold Inspiratory Muscle Training Praoperasi terhadap Kebugaran Kardiorespirasi Pascabedah Ganti Katup Jantung

2020 ◽  
Vol 7 (1) ◽  
pp. 82-90
Author(s):  
Aditya Paramitha ◽  
Sri Wahyudati ◽  
Wahyu Wiryawan ◽  
Sefri Noventi Sofia
Keyword(s):  
Valve Replacement ◽  
Heart Valve ◽  
Cardiorespiratory Fitness ◽  
Intervention Group ◽  
Inspiratory Muscle ◽  
Inspiratory Muscle Training ◽  
Heart Valve Replacement ◽  
Muscle Training ◽  
Replacement Surgery ◽  
Valve Replacement Surgery

Latar Belakang: Penyakit katup jantung memberikan beban kesehatan yang besar di seluruh dunia. Pasien yang menjalani bedah ganti katup jantung di RSUP Dr. Kariadi Semarang pada tahun 2018 adalah sebanyak 111 pasien. Pada pasien pasca bedah ganti katup jantung terjadi penurunan kebugaran kardiorespirasi. Kebugaran kardiorespirasi dapat diukur melalui pengukuran VO2max. Penambahan threshold inspiratory muscle training (Threshold IMT) praoperasi dianggap mampu menaikkan baseline kebugaran kardiorespirasi sehingga hasil keluaran pascabedah menjadi lebih baik, menurunkan risiko dan komplikasi operasi serta mempersingkat waktu pemulihan dan lama perawatan. Tujuan: Mengetahui pengaruh penambahan Threshold IMT praoperasi terhadap kebugaran kardiorespirasi pasien pascabedah ganti katup jantung. Metode: Penelitian ini merupakan penelitian quasi experimental. Pengambilan sampel penelitian dilakukan secara consecutive sampling, subyek dibagi menjadi kelompok perlakuan (n=9) dan kelompok kontrol (n=9). Kelompok perlakuan diberikan latihan rehabilitasi medik konvensional rutin sebelum bedah ganti katup jantung sesuai dengan Panduan Praktik Klinis (PPK) serta ditambahkan Threshold IMT sesuai protokol penelitian. Kelompok kontrol hanya melakukan latihan rehabilitasi medik konvensional. Hasil: Terdapat perbedaan yang bermakna secara klinis antar kelompok perlakuan dan kontrol pascabedah dengan minimal clinically important difference lebih dari 6%. Terdapat perbedaan yang bermakna secara statistik untuk nilai VO2max pra dan pascaperlakuan dalam kelompok perlakuan (p=0,021), serta antar kelompok perlakuan dan kontrol pascaperlakuan (p=0,026). Kesimpulan: Penambahan Threshold IMT praoperasi meningkatkan kebugaran kardiorespirasi pasien pra dan pascabedah ganti katup jantung. Kata kunci: Threshold inspiratory muscle training, VO2max.   Background: Heart valve disease presents a huge health burden worldwide. Patients who underwent cardiac valve replacement surgery at RSUP Dr. Kariadi Semarang in 2018 were 111 patients. Cardiorespiratory fitness declined in post-surgical patients. Cardiorespiratory fitness can be measured through VO2max. Additional preoperative threshold inspiratory muscle training (Threshold IMT) is considered to safely increase cardiorespiratory fitness baseline, reduce the risks and complications of surgery as well as shorter recovery time and treatment duration, thus postoperative outcomes will be better. Objective: To determine the effect of additional preoperative Threshold IMT on cardiorespiratory fitness in post heart valve replacement surgery patients. Method: This study is quasi experimental. Sampling was done by consecutive sampling, subjects were divided into two groups, intervention group (n=9) and control group (n=9). The intervention group was given routine conventional medical rehabilitation exercise before heart valve replacement surgery according to the Clinical Practice Guide (PPK) and added Threshold IMT according to the study protocol. The control group only did conventional medical rehabilitation exercises. Results: There was clinically significant difference post surgery between intervention and control groups with minimal clinically important difference of more than 6%. Statistically significant differences were obtained for the VO2max values ??pre and post treatment in the intervention group (p = 0.021) and between the intervention and control groups (p = 0.026) post-treatment. Conclusion: Addition of preoperative Threshold IMT increases cardiorespiratory fitness pre- and post-operative in heart valve replacement surgery patients. Keyword: Threshold inspiratory muscle training, VO2max.

scholarly journals Effects of a 10-Week Inspiratory Muscle Training Program on Lower-Extremity Mobility in People with Multiple Sclerosis

2011 ◽  
Vol 13 (1) ◽  
pp. 32-42 ◽  
Author(s):  
Lucinda Pfalzer ◽  
Donna Fry
Keyword(s):  
Multiple Sclerosis ◽  
Lower Extremity ◽  
Physical Performance ◽  
Intervention Group ◽  
Inspiratory Muscle ◽  
Inspiratory Muscle Training ◽  
Control Group ◽  
Muscle Training ◽  
Home Based ◽  
Edss Score

Pulmonary muscle weakness is common in ambulatory people with multiple sclerosis (MS) and may lead to deficits in mobility function. The purpose of this study was to examine the effect of a 10-week home-based exercise program using an inspiratory muscle threshold trainer (IMT) on the results of four lower-extremity physical performance tests in people with MS. The study design was a two-group (experimental-control), pretest-posttest study. Outcome measures consisted of pulmonary function measures including maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and maximal voluntary ventilation (MVV), and the following lower-extremity physical performance measures: the 6-Minute Walk (6MW) distance, gait velocity (GV), the Sit-to-Stand Test (SST), the Functional Stair Test (FST), and a balance test (BAL). A total of 46 ambulatory participants (Expanded Disability Status Scale [EDSS] score, 2.0–6.5) with MS were randomly assigned to an intervention group (mean EDSS score, 4.1) that received 10 weeks of home-based inspiratory muscle training or a nontreatment control group (mean EDSS score, 3.2). Of the original 46 participants, 20 intervention group participants and 19 control group participants completed the study. Compared with the control group, the intervention group made significantly greater gains in inspiratory muscle strength (P = .003) and timed balance scores (P = .008). A nonsignificant improvement in 6MW distance (P = .086) was also noted in the IMT-trained group as compared with the control group. This is the first study directly linking improvement in respiratory function to improvement in physical performance function in people with mild-to-moderate disability due to MS.

The effects of five days of intensive preoperative inspiratory muscle training on postoperative complications and outcome in patients having cardiac surgery: a randomized controlled trial

2019 ◽  
Vol 33 (5) ◽  
pp. 913-922 ◽  
Author(s):  
Xiaoyu Chen ◽  
Lin Hou ◽  
Yuanyuan Zhang ◽  
Xiangjing Liu ◽  
Bohan Shao ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Intervention Group ◽  
Pulmonary Complications ◽  
Inspiratory Muscle ◽  
Inspiratory Muscle Training ◽  
Control Group ◽  
Postoperative Pulmonary Complications ◽  
Muscle Training ◽  
Randomized Controlled ◽  
Inspiratory Muscle Strength

Objective: To determine the prophylactic efficacy of short-term intensive preoperative inspiratory muscle training on the incidence of postoperative pulmonary complications in patients scheduled for cardiac surgery. Design: Single-blind, randomized controlled pilot study. Setting: TEDA International Cardiovascular Hospital, China. Subjects: In total, 197 subjects aged ⩾50 years scheduled for cardiac surgery were selected. Intervention: The intervention group ( n = 98) received five days of preoperative inspiratory muscle training on top of the usual care received by the patients in the control group ( n = 99). Main measures: The primary outcome variable was the occurrence of postoperative pulmonary complications. The secondary outcome variables were inspiratory muscle strength, lung function and length of hospitalization. Results: After cardiac surgery, a total of 10 (10.2%) of the 98 patients in the intervention group and 27 (27.3%) of 99 patients in the control group had postoperative pulmonary complications (risk ratio, 0.23; 95% confidence interval (CI), 0.09–0.58, P = 0.002). The study revealed that, compared with the control group, the intervention group had a significant increase in inspiratory muscle strength (by 10.48 cm H2O, P < 0.001), forced expiratory volume in the first second of expiration (FEV1) %predicted (by 3.75%, P = 0.030), forced vital capacity (FVC) %predicted (by 4.15%, P = 0.008) and maximal voluntary ventilation (MVV) %predicted (by 6.44%, P = 0.034). Length of hospital stay was 7.51 (2.83) days in the intervention group and 9.38 (3.10) days in the control group ( P = 0.039). Conclusion: A five-day intensive pattern of preoperative inspiratory muscle training reduced the incidence of postoperative pulmonary complications and duration of postoperative hospitalization in patients undergoing cardiac surgery.

scholarly journals Role of per-operative milrinone on pulmonary hypertension having mitral valve replacement.

2021 ◽  
Vol 28 (01) ◽  
pp. 120-124
Author(s):  
Shahbaz Ahmad Khilji ◽  
Shuja Tahir ◽  
Shahid Abbas
Keyword(s):  
Pulmonary Hypertension ◽  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Nyha Class ◽  
Control Group ◽  
Study Group ◽  
Replacement Surgery ◽  
Valve Replacement Surgery

Objective: To determine the role of perioperative milrinone on pulmonary hypertension in patients with mitral valve disease undergoing mitral valve replacement surgery. Study Design: Randomized Control Trial. Setting: Department of Cardiac Surgery, Faisalabad Institute of Cardiology, Faisalabad. Period: June 2019 to June 2020. Material & Methods: A total of 80 patients with mitral valve disease who underwent mitral valve replacement were included. The patients were divided into a control group of 40, who were not administered milrinone, and a study group of 40 who received milrinone perioperatively. TVPG, LVEF and NYHA class were recorded preoperatively and postoperatively and were compared. Results: In the study group, postoperative LVEFs and NYHA class were not statistically significant in both groups while postoperative TVPG was significantly lower in study group as compare to control group and is statistically significant (P<0.001). Conclusion: Our study concludes that milrinone can be used as an effective therapy to reduce pulmonary pressure in patients with pulmonary hypertension undergoing mitral valve replacement surgery.

scholarly journals Clinical responses following inspiratory muscle training in exercise-induced laryngeal obstruction

2021 ◽  
Author(s):  
Astrid Sandnes ◽  
Tiina Andersen ◽  
Hege Havstad Clemm ◽  
Magnus Hilland ◽  
John-Helge Heimdal ◽  
...  
Keyword(s):  
Inspiratory Muscle ◽  
Inspiratory Muscle Training ◽  
University Hospital ◽  
Control Group ◽  
Activity Levels ◽  
Muscle Training ◽  
Symptom Resolution ◽  
Laryngeal Obstruction ◽  
Clinical Responses ◽  
Exercise Induced

Abstract Purpose Exercise-induced laryngeal obstruction (EILO) is relatively common in young people. Treatment rests on poor evidence; however, inspiratory muscle training (IMT) has been proposed a promising strategy. We aimed to assess laryngeal outcomes shortly after IMT, and to compare self-reported symptoms with a control group 4–6 years later. Methods Two groups were retrospectively identified from the EILO-register at Haukeland University Hospital, Norway; one group had received only information and breathing advice (IBA), and another additionally IMT (IBA + IMT). At diagnosis, all participants performed continuous laryngoscopy during exercise (CLE), with findings split by glottic and supraglottic scores, and completed a questionnaire mapping exercise-related symptoms. After 2–4 weeks, the IBA + IMT-group was re-evaluated with CLE-test. After 4–6 years, both groups were re-assessed with a questionnaire. Results We identified 116 eligible patients from the EILO-register. Response rates after 4–6 years were 23/58 (40%) and 32/58 (55%) in the IBA and IBA + IMT-group, respectively. At diagnosis, both groups rated symptoms similarly, but laryngeal scores were higher in the IBA + IMT-group (P = 0.003). After 2–4 weeks, 23/32 in the IBA + IMT-group reported symptom improvements, associated with a decrease of mainly glottic scores (1.7–0.3; P < 0.001), contrasting unchanged scores in the 9/32 without symptom improvements. After 4–6 years, exercise-related symptoms and activity levels had decreased to similar levels in both groups, with no added benefit from IMT; however, full symptom resolution was reported by only 8/55 participants. Conclusion Self-reported EILO symptoms had improved after 4–6 years, irrespective of initial treatment. Full symptom resolution was rare, suggesting individual follow-up should be offered.

Inspiratory muscle training does not improve clinical outcomes in 3-week COPD rehabilitation: results from a randomised controlled trial

2018 ◽  
Vol 51 (1) ◽  
pp. 1702000 ◽  
Author(s):  
Konrad Schultz ◽  
Danijel Jelusic ◽  
Michael Wittmann ◽  
Benjamin Krämer ◽  
Veronika Huber ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pulmonary Rehabilitation ◽  
Controlled Trial ◽  
Intervention Group ◽  
Inspiratory Muscle ◽  
Inspiratory Muscle Training ◽  
Chronic Obstructive ◽  
Muscle Training ◽  
Randomised Controlled

The value of inspiratory muscle training (IMT) in pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD) is unclear. The RIMTCORE (Routine Inspiratory Muscle Training within COPD Rehabilitation) randomised controlled trial examined the effectiveness of IMT added to pulmonary rehabilitation.In total, 611 COPD patients (Global Initiative for Chronic Obstructive Lung Disease stage II–IV) received a 3-week inpatient pulmonary rehabilitation, of which 602 patients were included in the intention-to-treat analyses. The intervention group (n=300) received highly intensive IMT and the control group (n=302) received sham IMT. The primary outcome was maximal inspiratory pressure (PImax). The secondary outcomes were 6-min walk distance, dyspnoea, quality of life and lung function. Outcomes were assessed pre- and post-pulmonary rehabilitation. ANCOVA was used.The intervention group showed higher effects in PImax (p<0.001) and forced inspiratory volume in 1 s (p=0.013). All other outcomes in both study groups improved significantly, but without further between-group differences. Sex and pulmonary rehabilitation admission shortly after hospitalisation modified quality of life effects.IMT as an add-on to a 3-week pulmonary rehabilitation improves inspiratory muscle strength, but does not provide additional benefits in terms of exercise capacity, quality of life or dyspnoea. A general recommendation for COPD patients to add IMT to a 3-week pulmonary rehabilitation cannot be made.

Effects of inspiratory muscle training on pulmonary function, respiratory muscle strength and functional capacity in patients with atrial fibrillation: a randomized controlled trial

2016 ◽  
Vol 30 (12) ◽  
pp. 1165-1174 ◽  
Author(s):  
Melih Zeren ◽  
Rengin Demir ◽  
Zerrin Yigit ◽  
Hulya N Gurses
Keyword(s):  
Atrial Fibrillation ◽  
Muscle Strength ◽  
Pulmonary Function ◽  
Functional Capacity ◽  
Respiratory Muscle ◽  
Inspiratory Muscle ◽  
Inspiratory Muscle Training ◽  
Control Group ◽  
Respiratory Muscle Strength ◽  
Muscle Training

Objective: To investigate the effects of inspiratory muscle training on pulmonary function, respiratory muscle strength and functional capacity in patients with atrial fibrillation. Design: Prospective randomized controlled single-blind study. Setting: Cardiology department of a university hospital. Subjects: A total of 38 patients with permanent atrial fibrillation were randomly allocated to either a treatment group ( n = 19; age 66.2 years (8.8)) or a control group ( n = 19; age 67.1 years (6.4)). Methods: The training group received inspiratory muscle training at 30% of maximal inspiratory pressure for 15 minutes twice a day, 7 days a week, for 12 weeks alongside the standard medical treatment. The control group received standard medical treatment only. Spirometry, maximal inspiratory and expiratory pressures and 6-minute walking distance was measured at the beginning and end of the study. Results: There was a significant increase in maximal inspiratory pressure (27.94 cmH2O (8.90)), maximal expiratory pressure (24.53 cmH2O (10.34)), forced vital capacity (10.29% (8.18) predicted), forced expiratory volume in one second (13.88% (13.42) predicted), forced expiratory flow 25%–75% (14.82% (12.44) predicted), peak expiratory flow (19.82% (15.62) predicted) and 6-minute walking distance (55.53 m (14.13)) in the training group ( p < 0.01). No significant changes occurred in the control group ( p > 0.05). Conclusion: Inspiratory muscle training can improve pulmonary function, respiratory muscle strength and functional capacity in patients with atrial fibrillation.

Nicorandil reduces myocardial injury and improves cardiac function in valve replacement surgery.

2019 ◽  
Vol 1 (4) ◽  
pp. 120-126
Author(s):  
Wael Elfeky ◽  
Mohamed Aboelnasr ◽  
Ayman Sallam ◽  
Wael Haseeb ◽  
Dalia R El-Afify
Keyword(s):  
Valve Replacement ◽  
Myocardial Protection ◽  
Myocardial Injury ◽  
Troponin I ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Replacement Surgery ◽  
Tnf Α ◽  
Valve Replacement Surgery

Background: Myocardial injury during cardiac surgery is associated with increased morbidity and mortality, and proper myocardial protection improves surgical outcomes. We aimed to study the role of preoperative nicorandil in myocardial protection during valve replacement surgery. Methods: The study included 40 patients who were randomized into two groups: control group, and nicorandil group. Preoperative, intraoperative, and postoperative data were collected. Creatine kinase- MB (CK-MB), troponin I, malondialdehyde (MDA), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were measured 24-hours before surgery then 4, 12 and 48 hours after aortic cross-clamp removal. Results: Nicorandil significantly decreased MDA (p=0.005 and 0.036), TNF-α (p< 0.001), IL-6 (p<0.001 and 0.003) 4 and 12 hours following the removal of aortic clamp compared to the control group. Additionally, It significantly reduced CK-MB (p< 0.0001 and 0.0002) and troponin-I (p= 0.0002 and < 0.0001) 4 and 12 hours after the removal of the aortic clamp, respectively. However, there was no significant difference in MDA, TNF-α, IL-6, CK-MB, and troponin-I levels between the nicorandil and the control group after 48 hours following the removal of aortic clamping (p= 0.084; 0.64; 0.12; 0.12; 0.75; respectively). Conclusions: Nicorandil reduced myocardial injury significantly in valve replacement surgery. Nicorandil decreased CK-MB and troponin I and improved postoperative left ventricular ejection fraction.

Effect of 4 weeks resistive inspiratory muscle training on respiratory functions in patients with tetraplegia during in-patient rehabilitation

2021 ◽  
Vol 12 (1) ◽  
pp. 536-543
Author(s):  
Gitanjali Sikka ◽  
Joginder Yadav ◽  
Roop Singh ◽  
Gupta K B
Keyword(s):  
Outcome Measures ◽  
T Test ◽  
Inspiratory Muscle ◽  
Inspiratory Muscle Training ◽  
Control Group ◽  
Muscle Training ◽  
Post Injury ◽  
Significant Difference ◽  
Cord Injury ◽  
And Control

There is reduction in lung compliance in first week after spinal cord injury (SCI) that deteriorates further and neuroprotective therapies like strength training of respiratory muscles should begin in first month after SCI  since both motor and sensory scores at baseline and their further recovery is maximum during this phase. Few studies on SCI subjects within first month of injury have supported use of resistive inspiratory muscle training (RIMT), but have advocated the need for further research in this patient population owing to pitfalls in these studies. The present study was a prospective randomized control trial being carried out to determine whether RIMT programme of four weeks duration is effective in improving respiratory functions and strength in motor complete cervical SCI patients (AIS grade A, B) during in-patient rehabilitation. Patients within first week of cervical SCI (C4-C7 level) were assigned to RIMT (48 patients) and Control (48 patients) group and completed 40 supervised training sessions over a period of four weeks. Outcome measures included: - Spirometry, inspiratory and expiratory muscle strength.  No significant differences of Chi-square test (P < 0.05) and unpaired “t” test (P < 0.05) were found between RIMT and Control group for all demographic and pre-training measurements. Following results were recorded after 2 weeks and 4 weeks of training on all outcome measures: - Highly significant difference  (P<0.01) within both groups with One–way ANOVA; Highly significant difference (P<0.01) with unpaired “t-test” between RIMT and control group. Cohen “d” effect sizes for RIMT vs. Control group were in large effect size zone i.e. greater than 0.8. The findings of present study show beneficial effect of RIMT on respiratory functions and strength in patients with tetraplegia in first month post injury and we propose that RIMT should be included early in acute phase rehabilitation of these patients.

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