Clinical Trials Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. May 27, 2023; 15(5): 688-698
Published online May 27, 2023. doi: 10.4254/wjh.v15.i5.688
Respiratory muscle training with electronic devices in the postoperative period of hepatectomy: A randomized study
Marcelo Gustavo Pereira, Aurea Maria Oliveira Silva, Fernanda Diório Masi Galhardo, Beatriz Dellamutta Miranda Almeida, Railaine Lais Lopes, Ilka de Fatima Santana Ferreira Boin
Marcelo Gustavo Pereira, Beatriz Dellamutta Miranda Almeida, Hospital de Clínicas, Universidade Estadual de Campinas, Campinas 13076-4151, São Paulo, Brazil
Aurea Maria Oliveira Silva, Ilka de Fatima Santana Ferreira Boin, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas 13083-887, São Paulo, Brazil
Fernanda Diório Masi Galhardo, Railaine Lais Lopes, Hospital de Clínicas da Unicamp, Universidade Estadual de Campinas, Campinas 13083-888, São Paulo, Brazil
Author contributions: Pereira MG designed the research study, participated in data collection, analyzed the data, wrote the manuscript and revised the manuscript; Silva AMO wrote the manuscript and revised the manuscript; Galhardo FDM wrote the manuscript and revised the manuscript; Almeida BDM participated in data collection; Lopes RL participated in data collection; Boin IFSF designed the research study, analyzed the data, revised the manuscript; all authors read and approved the final manuscript.
Institutional review board statement: This study was approved by the Research Ethics Committee of FCM-UNICAMP, Campinas, SP, having received authorization for data collection with Opinion: 2748781; CAAE: 90806218.7.0000.5404.
Clinical trial registration statement: It was registered in the Brazilian Registry of Clinical Trials (REBEC), UTN No: U 1111-1236-4194, available at:
Informed consent statement: Informed written consent was obtained from the patient and her family for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All participants agreed and signed the informed consent form, authorizing the use of data for the study. In the presentation of the data, there is no possibility of identifying the participants. As attached, the free and informed consent form and the approval of the ethics and research committee of the State University of Campinas.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
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:
Corresponding author: Marcelo Gustavo Pereira, BSc, MSc, Physiotherapist, Hospital de Clínicas, Universidade Estadual de Campinas, Rua Vital Brasil, 251, (CID. UNIVERSITÁRIA), Novo Taquaral, Campinas 13076-4151, São Paulo, Brazil.
Received: October 14, 2022
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
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

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.

Research results

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).

Research conclusions

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.

Research perspectives

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.