This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
To the Editor:
We read the study by Overbeek and colleagues1 with great attention. The manuscript is a secondary analysis of a previously published article that explored the potential role of preoperative inspiratory muscle training (IMT) on the postoperative pulmonary complication (PPC) rate after esophagectomy. Unfortunately, the study found negative results regarding reducing PPCs in subjects who underwent IMT.
We want to extend the discussion since PPC after esophagectomy is responsible for increased morbidity and mortality and represents a debate among different specialists, such as anesthesiologists and perioperative physicians.2
Overbeek and colleagues supposed that the primary mechanism by which IMT reduces PPC is the increased inspiratory capacity and better deep breathing after surgery due to an empowered diaphragm.
It is worth noting that pulmonary complications after esophagectomy are supposed to be caused by atelectasis as a result of multifactorial aspects:3
Intraoperative one-lung ventilation
Pneumoperitoneum or induced pneumothorax
Mediastinal dissection with the necessity of lung retraction to optimize esophageal exposure.
Other postoperative factors also increase the risk of their formation, such as diaphragmatic dysfunction with consequent impaired cough, pain, and reduced ability to clear tracheobronchial secretions.4 In addition, esophagectomy involves both abdominal and thoracic cavities, exposing the patients to a double-complications source. Considering all these aspects, it is difficult to assess the benefit of IMT on PPC …
Correspondence: Cristian Deana MD, Anesthesia and Intensive Care 1, Department of Anesthesia and Intensive Care, Piazzale S. M. della Misericordia 15, 33100 Udine, Italy. E-mail: Cristian.deana{at}asufc.sanita.fvg.it
Correspondence: E.A.E. Reijneveld MSc, HU University of Applied Sciences, Heidelberglaan 7, 3584, CS, Utrecht, the Netherlands E-mail: elja.reijneveld{at}hu.nl
Pay Per Article - You may access this article (from the computer you are currently using) for 1 day for US$30.00
Regain Access - You can regain access to a recent Pay per Article purchase if your access period has not yet expired.