Published online May 27, 2023. doi: 10.4254/wjh.v15.i5.688
Peer-review started: October 14, 2022
First decision: January 6, 2023
Revised: January 21, 2023
Accepted: March 6, 2023
Article in press: March 6, 2023
Published online: May 27, 2023
The study was developed in view of the growing number of surgical procedures and the need for scientific evidence that demonstrates the need for specialized physiotherapeutic evaluation to prevent and/or minimize postoperative complications. Inspiratory muscle training with an electronic device has been shown to be efficient in several pathologies, but limited in surgical patients with an indication to start in the preoperative period in order to assess and recognize respiratory mechanics, aiming to minimize and treat complications in the postoperative period.
Patients who undergo hepatectomy by laparotomy evolve with limited ventilatory mechanics. Respiratory restriction by the surgical incision, postoperative pain, diaphragmatic injury in the surgical procedure, subsequent weakness of the respiratory muscles, can lead to complications in the postoperative period. Inspiratory muscle training may be able to reduce the risk of pulmonary complications by improving the strength, resistance of respiratory muscles and lung function.
The objective of the present study was to evaluate and compare the strength of the respiratory muscles in the pre and postoperative periods of patients undergoing hepatectomy by laparotomy and to verify the incidence of postoperative pulmonary complications among the groups studied.
A prospective, randomized, clinical trial study that compared the inspiratory muscle training group with the control group. Data were collected in both groups, preoperatively, on the first and fifth postoperative days, vital signs and lung mechanics were evaluated and recorded. The value of albumin and bilirubin was noted for the albumin-bilirubin (ALBI) score. After randomization and allocation of participants, one group performed conventional physical therapy and the other group performed conventional physical therapy plus inspiratory muscle training, in both groups for five postoperative days.
Of the 41 participants included, the most frequent diagnosis was 41.5% with liver metastasis, followed by 26.8% with hepatocellular carcinoma. As for respiratory complications in inspiratory muscle training group (GTMI), there was no incidence. In the control group (CG), there were three respiratory complications. Patients in the CG classified with ALBI score 3 had, statistically, a higher energy value compared to patients classified with ALBI scores 1 and 2 (P = 0.0187). The respiratory variables, measured preoperatively and on the first postoperative day, had a significant drop in both groups from the preoperative period to the first postoperative day (P ≤ 0.0001). When comparing the preoperative period and the fifth postoperative day between the GTMI and the CG, the inspiratory muscle training variable in the GTMI was statistically significant (P = 0.0131).
All respiratory measures showed a reduction in the postoperative period. Respiratory muscle training using the Powerbreathe® device increased maximal inspiratory pressure and this may have contributed to a shorter hospital stay and better clinical outcome.
Through specific knowledge of the changes presented in the postoperative period, develop individualized protocols for inspiratory muscle training to minimize and avoid possible complications, improve the quality of care and reduce the length of stay of patients undergoing hepatectomy.