Preoperative Respiratory Training Before Cardiac Surgery: Feasibility and Longitudinal Pulmonary Function Changes in Elderly Patients.
Andranik Petrosyan, Emilie Besson, Nathalie Grand and 3 others
PMID 42464390WHAT IT FOUND
A three-week home incentive-spirometry programme before cardiac surgery was practical in these elderly patients, with high adherence and no adverse events.
Forced vital capacity rose but FEV1 did not, and with no control group the training cannot be credited.
Key findings
01Three weeks of physiotherapist-supervised incentive spirometry was feasible in these elderly cardiac surgery candidates: patients completed at least 80% of their expected daily sessions and no adverse events from the exercises were reported.
02Forced vital capacity rose from 4.22 L before training to 5.09 L afterwards (p = 0.036), while FEV1 did not change significantly (2.94 L to 3.06 L, p = 0.409).
03Thirty days after surgery both FVC and FEV1 were significantly below baseline (2.57 L and 1.80 L; both p < 0.001), and no postoperative pulmonary complications were recorded.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
There was no control group, no randomisation and no blinding, so nothing here can show that the training caused the rise in forced vital capacity; patients who improve on repeated testing may simply be getting better at the breathing test. Only 21 patients had full spirometry across all three time points, no sample size calculation was done, and the authors say the comparisons are exploratory, so small differences may be chance. The group was mixed: some patients had coronary artery disease, others valve disease needing different operations, and with this sample size the researchers could not adjust for diagnosis, surgical complexity or baseline lung reserve. Frailty, baseline functional capacity, breathlessness severity, respiratory muscle strength and quality of life were not measured, so it is unknown whether patients who struggled were the ones who changed most. Adherence came from patients' own logbooks, which tends to be over-reported, and some patients were supervised in person while three were only followed by phone. Only seven of the 27 patients were women, so the sex differences reported cannot be relied on. Patients with BMI over 30, severe obstructive lung disease, neuromuscular disorders or emergency surgery were excluded, so these results do not apply to frailer or more unwell patients on your caseload.
Declared interests
The authors state that they have nothing to report on funding and declare no conflicts of interest. No involvement of a device manufacturer or other company in designing, running or writing up the study is described. The incentive spirometer used (TriFlo 2, Hudson RCI, Teleflex Medical) is named in the methods.
The easy way to misread this
Do not read the rise in forced vital capacity as proof that preoperative breathing training works. There was no control group and no blinding, FEV1 did not change, and the absence of postoperative pulmonary complications in this small, selected group cannot be attributed to the programme.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →