• Meike C Overbeek, Elja Ae Reijneveld, Karin Valkenet, Edwin J van Adrichem, Jaap J Dronkers, Jelle P Ruurda, and Cindy Veenhof.
• Mss Overbeek and Reijneveld and Dr Dronkers are affiliated with Research Centre for Healthy and Sustainable Living, Research Group Innovation of Movement Care, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands. Drs Valkenet and Veenhof are affiliated with Research Centre for Healthy and Sustainable Living, Research Group Innovation of Movement Care, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands; and Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Center Utrecht, Brain Centre, Utrecht, Netherlands. Dr van Adrichem is affiliated with School of Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands. Dr Ruurda is affiliated with Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
• Respir Care. 2024 Feb 28; 69 (3): 290297290-297.

BackgroundPreoperative inspiratory muscle training (IMT) is frequently used in patients waiting for major surgery to improve respiratory muscle function and to reduce the risk of postoperative pulmonary complications (PPCs). Currently, the mechanism of action of IMT in reducing PPCs is still unclear. Therefore, we investigated the associations between preoperative IMT variables and the occurrence of PPCs in patients with esophageal cancer.MethodsA multi-center cohort study was conducted in subjects scheduled for esophagectomy, who followed IMT as part of a prehabilitation program. IMT variables included maximum inspiratory pressure (PImax) before and after IMT and IMT intensity variables including training load, frequency, and duration. Associations between PImax and IMT intensity variables and PPCs were analyzed using independent samples t tests and logistic regression analyses, corrected for age and pulmonary comorbidities and stratified for the occurrence of anastomotic leakages.ResultsEighty-seven subjects were included (69 males; mean age 66.7 ± 7.3 y). A higher PImax (odds ratio 1.016, P = .07) or increase in PImax during IMT (odds ratio 1.020, P = .066) was not associated with a reduced risk of PPCs after esophagectomy. Intensity variables of IMT were also not associated (P ranging from .16 to .95) with PPCs after esophagectomy. Analyses stratified for the occurrence of anastomotic leakages showed no associations between IMT variables and PPCs.ConclusionsThis study shows that an improvement in preoperative inspiratory muscle strength during IMT and training intensity of IMT were not associated with a reduced risk on PPCs after esophagectomy. Further research is needed to investigate other possible factors explaining the mechanism of action of preoperative IMT in patients undergoing major surgery, such as the awareness of patients related to respiratory muscle function and a diaphragmatic breathing pattern.Copyright © 2024 by Daedalus Enterprises.

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