Meta-Analysis
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 6, 2023; 11(13): 2981-2991
Published online May 6, 2023. doi: 10.12998/wjcc.v11.i13.2981
Effect of preoperative inspiratory muscle training on postoperative outcomes in patients undergoing cardiac surgery: A systematic review and meta-analysis
Jing Wang, Yu-Qiang Wang, Jun Shi, Peng-Ming Yu, Ying-Qiang Guo
Jing Wang, Yu-Qiang Wang, Jun Shi, Ying-Qiang Guo, Department of Cardiovascular Surgery, Sichuan University West China Hospital, Chengdu 610041, Sichuan Province, China
Peng-Ming Yu, Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Wang J and Yu PM designed the study; Wang J and Wang YQ searched the literature and extracted the data; Shi J contributed to data verification; Wang J, Yu PM, and Wang YQ analyzed the data; Wang J, Wang YQ, Shi J, Yu PM, and Guo YQ interpreted the data; Wang J drafted the manuscript; Wang YQ, Shi J, Yu PM, and Guo YQ critically reviewed the manuscript; Guo YQ had full access to all the data and carries responsibility for the decision to submit it for publication; all authors read and approved the final manuscript.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to report.
PRISMA 2009 Checklist statement: We performed this systematic review and meta-analysis according to the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. Meanwhile, it has been registered with PROSPERO (ID: CRD42022333441).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ying-Qiang Guo, MD, PhD, Chief Doctor, Doctor, Surgeon, Department of Cardiovascular Surgery, Sichuan University West China Hospital, No. 37 Guoxue Lane, Wuhou District, Chengdu 610041, Sichuan Province, China. drguoyq@wchscu.cn
Received: November 12, 2022
Peer-review started: November 12, 2022
First decision: January 30, 2023
Revised: February 10, 2023
Accepted: March 31, 2023
Article in press: March 31, 2023
Published online: May 6, 2023
Abstract
BACKGROUND

Cardiovascular disease is the most prevalent disease worldwide and places a great burden on the health and economic welfare of patients. Cardiac surgery is an important way to treat cardiovascular disease, but it can prolong mechanical ventilation time, intensive care unit (ICU) stay, and postoperative hospitalization for patients. Previous studies have demonstrated that preoperative inspiratory muscle training could decrease the incidence of postoperative pulmonary complications.

AIM

To explore the effect of preoperative inspiratory muscle training on mechanical ventilation time, length of ICU stay, and duration of postoperative hospitalization after cardiac surgery.

METHODS

A literature search of PubMed, Web of Science, Cochrane Library, EMBASE, China National Knowledge Infrastructure, WanFang, and the China Science and Technology journal VIP database was performed on April 13, 2022. The data was independently extracted by two authors. The inclusion criteria were: (1) Randomized controlled trial; (2) Accessible as a full paper; (3) Patients who received cardiac surgery; (4) Preoperative inspiratory muscle training was implemented in these patients; (5) The study reported at least one of the following: Mechanical ventilation time, length of ICU stay, and/or duration of postoperative hospitalization; and (6) In English language.

RESULTS

We analyzed six randomized controlled trials with a total of 925 participants. The pooled mean difference of mechanical ventilation time was -0.45 h [95% confidence interval (CI): -1.59-0.69], which was not statistically significant between the intervention group and the control group. The pooled mean difference of length of ICU stay was 0.44 h (95%CI: -0.58-1.45). The pooled mean difference of postoperative hospitalization was -1.77 d in the intervention group vs the control group [95%CI: -2.41-(-1.12)].

CONCLUSION

Preoperative inspiratory muscle training may decrease the duration of postoperative hospitalization for patients undergoing cardiac surgery. More high-quality studies are needed to confirm our conclusion.

Keywords: Preoperative inspiratory muscle training, Cardiac surgery, Heart surgery, Mechanical ventilation, Intensive care unit, Duration of postoperative hospitalization

Core Tip: For cardiac surgery patients, the use of inspiratory muscle training could reduce the incidence of postoperative pulmonary complications according to previous research. Our study demonstrated that it could shorten the duration of postoperative hospitalization and thus may decrease overall costs. More research is needed to explore the effect of inspiratory muscle training on mechanical ventilation time and length of intensive care unit stay.