Preliminary effectiveness and feasibility of two pre-operative Inspiratory Muscle Training (IMT) interventions in patients undergoing oesophageal resection.

Objective:

To examine the preliminary effectiveness of preoperative IMT high-intensity in patients undergoing oesophagus resection on postoperative pulmonary complications, inspiratory muscle strength/endurance and IC stay compared to preoperative IMT –endurance. Secondary objective is to examine the feasibility (i.e. patient satisfaction, compliance) of preoperative IMT high-intensity in patients undergoing thoracic surgery (for oesophagus resection) compared to preoperative IMT –endurance.



Study design:

Randomized Controlled Trial, with blinded observers.



Study population:

Patients undergoing oesophagus resection, age 18-85 yr.



Intervention:

Both IMT interventions will consist of preoperative, individually tailored breathing exercises during 3 – 6 weeks prior to surgery. The IMT will be given with a Treshold IMT device, which provide a constant, sustained pressure challenge throughout the entire inspiration that is independent of airflow. The IMT endurance training starts at a resistance of 30% of MIP and the patient breathes through the device during 20 minutes. The resistance will be increased with 5%, if the perceived exertion scored on the Borg scale (0-10) is less than 5. The IMT high intensity training starts at 60 % of MIP and contains 6 cycles of 6 inspiratory breathing manoeuvres. The load will be increased to maximal load.



Main study parameters/endpoints:

Postoperative pulmonary complications, maximal inspiratory muscle strength and endurance, compliance rate, duration of IC stay/general ward, lself-efficacy, anxiety and patient satisfaction.

Both modalities of IMT will reduce postoperative pulmonary complications and IC stay.

T1= Pre pIMT;

T2 = Post pIMT;

T3 = Post surgery, discharge.

1. The IMT endurance training starts at a resistance of 30% of MIP and the patient breathes through the device during 20 minutes. The resistance will be increased with 5%, if the perceived exertion scored on the Borg scale (0-10) is less than 5;

2. The IMT high intensity training starts at 60 % of MIP and contains 6 cycles of 6 inspiratory breathing manoeuvres. The load will be increased to maximal load.



Both interventies will be provided between 1 and 6 weeks preoperatively.