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Randomized Controlled Trial F1000Research. 2020 Mar 9:9:172. doi: 10.12688/f1000research.22040.1 0.02024

Findings of a feasibility study of pre-operative pulmonary rehabilitation to reduce post-operative pulmonary complications in people with chronic obstructive pulmonary disease scheduled for major abdominal surgery

慢性阻塞性肺疾病全麻下腹部手术患者的术前康复研究发现可减少术后并发症 翻译改进

Lucy L Marlow  1  2, Angeline H Y Lee  1, Emma Hedley  3, Michael P Grocott  4  5, Michael C Steiner  6, J Duncan Young  1, Najib M Rahman  3, Christopher P Snowden  7, Kyle T S Pattinson  1

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作者单位

  • 1 Nuffield Division of Anaesthetics, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
  • 2 Warwick Medical School, The University of Warwick, Coventry, UK.
  • 3 Division of Experimental Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
  • 4 Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
  • 5 Anaesthesia Perioperative and Critical Care Research Group, Southampton National Institute of Health Research (NIHR) Biomedical Research Centre, University Hospital Southampton, Southampton, UK.
  • 6 Leicester Respiratory Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester, UK.
  • 7 The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle University, Newcastle upon Tyne, UK.
  • DOI: 10.12688/f1000research.22040.1 PMID: 33299545

    摘要 Ai翻译

    Background: Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of complications and death following surgery. Pulmonary complications are particularly prominent. Pulmonary rehabilitation is a course of physical exercise and education that helps people with COPD manage their condition. Although proven to improve health outcomes in patients with stable COPD, it has never been formally tested as a pre-surgical intervention in patients scheduled for non-cardiothoracic surgery. If a beneficial effect were to be demonstrated, pulmonary rehabilitation for pre-surgical patients with COPD might be rapidly implemented across the National Health Service, as pulmonary rehabilitation courses are already well established across much of the United Kingdom (UK). Methods: We performed a feasibility study to test study procedures and barriers to identification and recruitment to a randomised controlled trial testing whether pulmonary rehabilitation, delivered before major abdominal surgery in a population of people with COPD, would reduce the incidence of post-operative pulmonary complications. This study was run in two UK centres (Oxford and Newcastle upon Tyne). Results: We determined that a full randomised controlled trial would not be feasible, due to failure to identify and recruit participants. We identified an unmet need to identify more effectively patients with COPD earlier in the surgical pathway. Service evaluations suggested that barriers to identification and recruitment would likely be the same across other UK hospitals. Conclusions: Although pulmonary rehabilitation is a potentially beneficial intervention to prevent post-operative pulmonary complications, a randomised controlled trial is unlikely to recruit sufficient participants to answer our study question conclusively at the present time, when spirometry is not automatically conducted in all patients planned for surgery. As pulmonary rehabilitation is a recommended treatment for all people with COPD, alternative study methods combined with earlier identification of candidate patients in the surgical pathway should be considered. Trial registration: ISRCTN29696295, 31/08/2017.

    Keywords: pulmonary rehabilitation; respiratory.

    Keywords:major abdominal surgery

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    Findings of a feasibility study of pre-operative pulmonary rehabilitation to reduce post-operative pulmonary complications in people with chronic obstructive pulmonary disease scheduled for major abdominal surgery