Inspiratory Muscle Training Before Esophagectomy Increases Diaphragmatic Excursion: A Randomized Controlled Trial

Area of Science:

• Respiratory Physiology
• Surgical Oncology
• Pulmonary Rehabilitation

Background:

• Inspiratory muscle training (IMT) is known to prevent postoperative pulmonary complications (PPCs) after abdominal surgery.
• The effect of IMT on diaphragmatic function, specifically diaphragmatic excursion (DE), remains unevaluated.
• This study focuses on esophageal cancer patients undergoing esophagectomy.

Purpose of the Study:

• To investigate the impact of preoperative IMT on diaphragmatic excursion (DE).
• To assess the efficacy of preoperative IMT in preventing PPCs in esophageal cancer patients.
• To evaluate changes in DE using ultrasonography.

Main Methods:

• An unblinded, parallel, randomized controlled trial was conducted.
• Patients with esophageal cancer were randomized to either incentive spirometry (IS) or IMT groups.
• IMT involved a fixed inspiratory resistance (50% maximal inspiratory pressure) during neoadjuvant chemotherapy.

Main Results:

• The IMT group demonstrated a significant increase in DE post-intervention compared to the IS group.
• A lower incidence of Clavien-Dindo grade II or higher PPCs was observed in the IMT group.
• 40 patients completed the analysis, with 5 experiencing PPCs.

Conclusions:

• Preoperative IMT significantly increases diaphragmatic excursion (DE) in esophageal cancer patients.
• Enhanced DE through IMT may play a crucial role in preventing postoperative pulmonary complications (PPCs).
• IMT is a promising intervention for improving outcomes in patients undergoing esophagectomy.