Respiratory prehabilitation for the prevention of postoperative pulmonary complications after major surgery

Purpose of Review:

Despite modern advances in perioperative medicine, postoperative pulmonary complications (PPCs) remain a significant problem. This paper reviews the current evidence for respiratory prehabilitation to prevent PPCs in major surgical populations.

Recent Findings:

A large multicentre international 2018 trial conducted within a modern perioperative framework confirmed previous findings that a physiotherapy-led education and breathing exercise training session delivered in preadmission clinics is a highly cost-effective method to significantly reduce PPC incidence. A 2020 meta-analysis of ten small clinical trials finds another mode of respiratory prehabilitation, inspiratory muscle training, which is also likely to reduce PPC. Five large clinical trials are currently underway to confirm these findings with results expected in 2023.

Summary:

There is consistent evidence that patients who are taught preoperatively by a physiotherapist on how to perform breathing exercises after surgery or who strengthen their respiratory muscles before surgery with a loaded resistive breathing device can halve their risk of developing a PPC after major surgery. Further research is required to consider the generalisability across a variety of surgical populations, and the relative value of different modes, devices, dosages, and if PPC reductions can be further enhanced with the augmentation of preoperative whole-body exercise therapy.