Objective: To compare the postoperative outcomes of inspiratory muscle training and aerobic exercise, along with standard care, on lung cancer patients undergoing video-assisted thoracoscopic surgery (VATS). Design: A parallel-group, single-blind randomized clinical trial Setting: Thoracic surgery ward and outpatient clinic in a teaching hospital Subjects: Overall 63 patients underwent VATS were randomly assigned to a triaging (TG, n = 32) or control group (CG, n = 31). A total of 54 patients (TG, n = 26; CG, n = 28) completed the study. Intervention: TG: six-week threshold inspiratory muscle training and aerobic exercise. CG: standard care. Main measures: Maximum inspiratory pressure (PImax), maximum expiratory pressure (PEmax) lung expansion volume, and 6-min walking test (6MWT) were performed on the day of chest tube removal (baseline), and 2, 6, and 12 weeks postoperatively. Results: The TG showed significant improvement in PImax at week 6 (71.6 ± 34.9 vs. 94.3 ± 32.8 cmH2O, P = 0.018), PEmax at week 2 (70.9 ± 24.3 vs. 90.9 ± 28.2 cmH2O, P = 0.015) and week 12 (76.1 ± 20.2 vs. 98.6 ± 35.3 cmH2O, P = 0.012), the lung expansion volume at week 2 (1080 ± 433 vs 1457 ± 624 mL, P = 0.02) and week 12 (1200 ± 387 vs 1885 ± 678 mL, P < 0.001), in addition to the 6MWT at week 2 (332 ± 78 vs 412 ± 74 m, P = 0.002), week 6 (360 ± 70 vs 419 ± 60 m, P = 0.007) and week 12 (360 ± 58 vs 402 ± 65 m, P = 0.036). Conclusion: A six weeks of inspiratory muscle training and aerobic exercise had improved respiratory muscle strength and aerobic exercise postoperatively in lung cancer patients after VATS as early as 2 weeks.

BackgroundPatient-ventilator asynchrony is a common problem in mechanically ventilated patients; the problem is especially obvious in COPD. Neutrally adjusted ventilatory assist (NAVA) can improve patient-ventilator asynchrony; however, the effect in COPD patients with prolonged mechanical ventilation is still unknown. The goals of this study are to evaluate the effect of NAVA and conventional weaning mode in patients with COPD during prolonged mechanical ventilation.MethodsThe study enrolled a total of 33 COPD patients with ventilator dependency for more than 21 days in the weaning center. A diaphragm electrical activity (Edi) catheter was inserted in patients within 24 hours after admission to the respiratory care center, and patients were randomly allocated to NAVA or conventional group. A spontaneous breathing trial was performed every 24 hours. The results correlated with the clinical parameters.ResultsThere were significantly higher asynchrony incidence rates in the whole group after using Edi catheter (before vs post-Edi catheter insertion =60.6% vs 87.9%, P<0.001). Asynchrony index: before vs post-Edi catheter insertion =7.4%±8.5% vs 13.2%±13.5%, P<0.01. Asynchrony incidence: NAVA vs conventional =0% vs 84.2%, P<0.001. Asynchrony index: NAVA vs conventional =0 vs 11.9±11.2 (breath %), P<0.001. The most common asynchrony events were ineffective trigger and delayed trigger.ConclusionCompared to conventional mode, NAVA mode can significantly enhance respiratory monitoring and improve patient-ventilator interaction in COPD patients with prolonged mechanical ventilation in respiratory care center.

Both pulmonary function and autonomic function are impaired in patients with Parkinson’s diseases (PD). This study tested the hypothesis that respiratory muscle training (RMT) can not only improve pulmonary function, but also simultaneously improve cardiovascular autonomic function and short-term functional outcomes in patients with PD. Pulmonary function was measured by the forced vital capacity (FVC), forced expiratory volume in one second (FEV1), maximum inspiratory pressures (MIP), and maximum expiratory pressures (MEP). Cardiovascular autonomic function was measured by the heart rate response to deep breathing (HRDB), Valsalva ratio, baroreflex sensitivity, and spectral analysis. The functional and severity scores were measured by the Hoehn and Yahr stage and Unified Parkinson’s Disease Rating Scale (UPDRS). These measures were evaluated in patients with PD before and after 3 months of RMT, compared with a control group of PD patients without RMT. The results showed significant improvement of clinical scores (total UPDRS and UPDRS I, II and III) after RMT (p < 0.0001). Concerning pulmonary function, the parameters of MIP and MEP improved significantly. The parameters of cardiovascular function also improved after RMT, although only HRDB reached statistical significance. Based on the results of our study, RMT can not only improve both pulmonary and cardiovascular autonomic function, but can also improve short-term functional outcomes in patients with PD.