Different inspiratory muscle training methods improve exercise and cardiopulmonary function of patients after cardiac surgery:a network meta-analysis

Chen Ping; Du Jinchao; Wang Hongying; Zhang Hui; Wang Haixia

doi:10.12307/2026.702

Abstract：OBJECTIVE:Inspiratory muscle training can increase inspiratory muscle strength and endurance,thereby improving maximum inspiratory negative pressure and cardiopulmonary function,reducing the incidence of complications,and aiding patient recovery.Herein,a systematic review is conducted to evaluate the differences in efficacy between different inspiratory muscle training modalities on functional recovery in cardiac surgery patients. METHODS:We searched CNKI,VIP,WanFang,CBM,PubMed,Embase and Cochrane Library to collect randomized controlled trials about inspiratory muscle training applied to cardiac surgery from database inception to November 2024.Language was limited to Chinese and English.Subject terms were combined with keywords during the search process.After screening,we performed a meta-analysis using Review Manager 5.4 and Stata 14.2. RESULTS:(1)Finally,24 papers were included,including 11 high-quality papers and 13 low-quality papers,totaling 1 907 patients and 4 inspiratory muscle training modes.(2)Direct meta-analysis results indicated that after sensitivity analysis,compared with the control group,inspiratory threshold load training,inspiratory resistance load training,and high carbon dioxide inspiratory training had a significant effect on inspiratory muscle function[mean difference=-15.01,95%confidence interval(CI)(-18.72,-11.30),P<0.01],motor function[standardized mean difference=-0.60,95%CI(-0.82,-0.38),P<0.01],and cardiorespiratory function score[standardized mean difference=-0.66,95%CI(-1.26,-0.07),P=0.03].There were significant differences in the incidence of pneumonia[odds ratio=2.42,95%CI(1.44,4.06),P<0.01]and pulmonary atelectasis[odds ratio=6.18,95%CI(1.85,20.64),P<0.01].(3)The results of network meta-analysis showed that in terms of improvement in inspiratory muscle function,the therapeutic efficacy was ranked as inspiratory threshold loading training(92.6)>inspiratory resistance loading training(57.4)>conventional inspiratory training(0);and in terms of improvement in motor function,the therapeutic efficacy was ranked as inspiratory threshold loading training(100)>high carbon dioxide inspiratory training(66.4)>inspiratory resistance loading training(33.6)>conventional inspiratory training(0);and in terms of improvement in cardiorespiratory function,the therapeutic efficacy was ranked as inspiratory threshold loading training(94.4)>high carbon dioxide inspiratory training(52.2)>inspiratory resistance loading training(44.8)>conventional inspiratory training(8.2). CONCLUSION:The available clinical evidence suggests that inspiratory threshold loading training has the best efficacy in improving inspiratory muscle function,motor function,and cardiorespiratory function of patients undergoing cardiac surgery,followed by high carbon dioxide inspiratory training and inspiratory resistance loading training.However,due to the low methodological quality of some of the included studies,there is an urgent need for high-quality studies to validate this finding.