Postoperative pulmonary complications (PPC), such as pneumonia and atelectasis, are a major cause of morbidity and mortality after major cardiac or abdominal surgery. Pulmonary complications can prolong hospital stays and increase medical costs.
Perioperative RMT using a "ventilator" reduces PPC risk, morbidity and mortality, and shortens hospital stay.
Additionally, RMT reduces the risk of tracheal intubation and supports liberation from mechanical ventilation. RMT can shorten the offline time and improve the offline success rate.
Purpose of usage
- Strengthen the inspiratory muscles (diaphragm, external intercostal muscles, accessory neck muscles) and expiratory muscles (internal intercostal muscles, abdominal muscles)
- Promote diaphragmatic breathing
- Improve protective cough and help clear the airway
- Improve respiratory support and achieve safe swallowing function
- Improve movement of glossopharyngeal complex
Specific clinical benefits
- Increase maximum inspiratory and expiratory pressure (PImax, PEmax)
- Improve diaphragm function and increase diaphragm thickness
- Increase blood oxygen saturation
- Reduce systolic and diastolic blood pressure
- Improve laryngeal function and facilitate speaking and swallowing
- Improve reflex cough and improve lung hygiene
Specific benefits for hospitalized patients
- Shorten the time of mechanical ventilation
- Improve the success rate of weaning from mechanical ventilation
- Reduce the risk of postoperative pneumonia and atelectasis
- Shorten hospital stay
- Reduce in-hospital mortality
- Reduce the risk of tracheal intubation
Other benefits
- Improve quality of life(QOL)
- Reduce hospitalization and healthcare needs
- Reduce the risk of death
Training Programs:
Note: These are program recommendations based on clinical evidence from RMT. These recommendations should not replace the therapist's clinical judgment and will still need to be adapted to each patient's case, condition, and preferences.
Preoperative RMT:
Begin RMT with respiratory dumbbells 2 weeks before surgery, using the highest tolerated setting and gradually increasing it as follows
If BORG < 5, at least 2 sets of 10 breaths twice a day, 7 days a week, in addition to standard care. Reinitiate RMT under tolerated conditions at the time of postoperative extubation.
Postoperative RMT:
Start RMT with breathing dumbbells as soon as surgical clearance or extubation is granted. 2 sets of 10 breaths per set, at least twice a day, 7 days a week.
Disengagement from mechanical ventilation:
For patients who are difficult to extricate from mechanical ventilation, perform 1 set of 10 breaths per group at least twice a day, 7 days a week, with a 1- to 2-minute break in between each breath. Successful extrication is assessed by a daily voluntary breathing test. If a breathing dumbbell is unavailable during deconditioning, it may be attached directly to the mechanical ventilation catheter after the patient is able to perform resistance breathing.